Tension-Sided Femoral Neck Stress Fracture in a Skeletally Immature Patient

Pithwa, Yogesh Kishorkant; Rajasekaran, Shanmuganathan

doi:10.2106/00004623-200406000-00025

Cited by 21 publications

(8 citation statements)

References 22 publications

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“…Although the majority of these are compression-sided fractures, there are case reports of tensionsided fractures in youth. 153 Tension-sided fractures should be referred to an orthopaedic specialist and treated with strict nonweightbearing and/or open reduction with internal fixation just as in adults because of the risk of non-union, progression to a pathological fracture and development of avascular necrosis. 152 Patella Case reports of patellar stress fractures in children exist, but the true incidence is unknown.…”

Section: Femoral Neckmentioning

confidence: 99%

Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine

DiFiori¹,

et al. 2014

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BackgroundYouth sport participation offers many benefits including the development of self-esteem, peer socialisation and general fitness. However, an emphasis on competitive success, often driven by goals of elite-level travel team selection, collegiate scholarships, Olympic and National team membership and even professional contracts, has seemingly become widespread. This has resulted in an increased pressure to begin high-intensity training at young ages. Such an excessive focus on early intensive training and competition at young ages rather than skill development can lead to overuse injury and burnout. PurposeTo provide a systematic, evidenced-based review that will (1) assist clinicians in recognising young athletes at risk for overuse injuries and burnout; (2) delineate the risk factors and injuries that are unique to the skeletally immature young athlete; (3) describe specific high-risk overuse injuries that present management challenges and/or can lead to long-term health consequences; (4) summarise the risk factors and symptoms associated with burnout in young athletes; (5)provide recommendations on overuse injury prevention. MethodologyMedical Subject Headings (MeSHs) and text words were searched on 26 March 2012 from MEDLINE, CINAHL and PsycINFO. The search yielded 953 unique articles. Additional articles were found using cross-referencing. The process was repeated on 10 July 2013 to review any new articles since the original search. Screening by the authors yielded a total of 208 relevant sources that were used for this article. Recommendations were classified using the Strength of Recommendation Taxonomy (SORT) grading system. Definition of overuse injuryOveruse injuries occur due to repetitive submaximal loading of the musculoskeletal system when rest is not adequate to allow for structural adaptation to take place. Injury can involve the muscletendon unit, bone, bursa, neurovascular structures and the physis. Overuse injuries unique to young athletes include apophyseal injuries and physeal stress injuries. EpidemiologyIt is estimated that 27 million US youth between 6 and 18 years of age participate in team sports. The National Council of Youth Sports survey found that 60 million children aged 6-18 years participate in some form of organised athletics, with 44 million participating in more than one sport. There is very little research specifically on the incidence and prevalence of overuse injuries in children and adolescents. Overall estimates of overuse injuries versus acute injuries range from 45.9% to 54%. The prevalence of overuse injury varies by the specific sport, ranging from 37% (skiing and handball) to 68% (running). Overuse injuries are underestimated in the literature because most of the epidemiological studies define injury as requiring a time loss from participation. Risk factorsPrior injury is a strong predictor of future overuse injury. Overuse injuries may be more likely to occur during the adolescent growth spurt. The physes, apophyses and articular surfaces in skeletally immat...

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Section: Femoral Neckmentioning

confidence: 99%

Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine

DiFiori¹,

et al. 2014

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“…He was also the first to distinguish between two types of stress fractures of the femoral neck: a transverse fracture and a compression fracture [1]. One case described a child with a tension fracture of the femoral neck, who was treated with cannulated screws [14]. These fractures are prone to displacement and therefore require immediate surgical fixation.…”

Section: Discussionmentioning

confidence: 99%

“…One case described a child with a tension fracture of the femoral neck, who was treated with cannulated screws [14]. However, no reports of underlying medical conditions for a femoral stress fracture in children exist in the literature [3,[5][6][7][9][10][11][12][13][14]. As these fractures are stable, they only require partial or non-weight-bearing treatment with crutches.…”

Section: Discussionmentioning

confidence: 99%

Stress fracture of the femoral neck in a child

Fievez

Hanssen

Schotanus

et al. 2013

Journal of Pediatric Orthopaedics B

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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.

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“…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.…”

Section: Stress Fracture Of the Neck Of The Femurmentioning

confidence: 99%