Stress fracture of the femoral neck in a child

Abstract

A 7-year-old boy developed complaints of pain in the left groin. These complaints started spontaneously. Initial plain radiographs of the pelvis indicated no abnormalities. As the symptoms persisted for 6 weeks, the young patient and his parents visited our institution. Clinical investigation showed a slight extension deficit of the left hip. New radiographs and MRI indicated a fracture line with sclerosis along the inferior border of the left femoral neck. In retrospect, this stress fracture of the femoral neck was also visible on the initial radiographs. Seven months after the onset of complaints in the left groin and prescribed partial weight bearing with crutches, callus formation with consolidation of the femoral neck was observed on radiographs. Eleven months after onset, the patient recovered fully without any residual symptoms. After 21 months, the young patient did not have any complaints or restrictions in physical activity. Because of its highly rare nature, stress fractures of the femoral neck in children are easy to miss initially. This was also applicable in our case. Extensive differential diagnosis of a child with pain in the groin furthermore adds to the difficulty in the diagnosis of a stress fracture of the femoral neck. This case report emphasizes the importance of the evaluation of radiographs and observation in children with hip complaints. Similarly, interdisciplinary consultation and cooperation between the general practitioner, orthopaedic surgeon, radiologist and paediatrician is essential in the diagnosis, evaluation and treatment of these young patients.

Bilateral Femoral Neck Stress Fracture in Child: A Case Report

“…The common symptoms of previously described cases were sustained hip pain and limping. Some cases had a history of excessive sports activity and problems affecting general health condition, such as anorexia nervosa 2 7) , whereas others had no clear contributory factors 4 8) . Our patient had no history of trauma or medical problems.…”

“…Femoral neck stress fractures occur mainly in athletes, military trainees, physically hyperactive people, and patients with metabolic disorders or who are undernourished 2) . Since Devas 3) first described cases of femoral neck stress fractures in children and classified the fractures into two types in 1963, only about 20 cases have been reported 1 3 4) .…”

Paediatric Orthopaedic Diagnosis

“…Though stress fractures of the femoral neck in children are not common, reports of this entity have appeared with regular frequency in the literature (Fiévez et al 2012 ;Lehman and Shah 2004 ;Maezawa et al 2004 ;Scheerlinck and De Boeck 1998 ). Compression and tension stress fractures of the femoral neck have been reported.…”