A femoral neck stress fracture is a worrisome cause of hip and groin pain in athletes. Typically they are seen in runners or other athletes who perform repetitive impact to the lower extremities. Like most stress fractures, these injuries occur in athletes who are putting more stress on a particular part of their body without enough time to recover. The history often involves a runner who is increasing his or her training over too quick a period of time without enough rest. These are usually seen in perimenopusal women who are losing bone during these years, but they can be seen in other age groups.
As with most stress fractures, patients will complain of increasing pain during runs that comes on earlier and earlier over the days and weeks that the problem persists. The pain will also start to take longer to go away, and occasionally it will hurt with activities of daily living, such as walking. Typically pain from a femoral neck stress fracture is felt more in the groin than the lateral side (outside) of the hip or in the buttock. Often range of motion causes groin pain. Physical examination will note pain in the groin and pain with range of motion, but it can often be difficult to localize the pain specifically to the femoral neck. X-rays will often show the injury as a nondisplaced or hairline fracture through the neck of the femur, or at least one side of it. Occasionally a bone scan or an MRI is needed to make the diagnosis.
Treatment of the femoral neck stress fracture depends on where the injury occurs. On the lower side of the femoral neck, nonsurgical treatment is often adequate. Unfortunately these are serious injuries, so often sports medicine physicians will place the patient on crutches and make the patient completely nonweightbearing. On the upper side (superior) of the femoral neck, these are more worrisome injuries that often do not heal with nonoperative treatment. Surgical treatment involves placing several screws into the femoral neck to compress the fracture and get it to heal.
Regardless of the treatment, activities are limited until the fracture heals. Often being completely nonweightbearing is necessary for several weeks, and sports are restricted for three to four months. While the recovery and healing process is lengthy, often return to sports is uneventful once healing occurs. It is often a good idea to identify the reasons the stress fracture occurred. Often a referral for an evaluation for osteoporosis with bone density screening is indicated.