Femoral Neck Stress Fracture

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.

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31 Responses to Femoral Neck Stress Fracture

  1. I am currently sixteen, almost seventeen and I have had severe pains dating back eight years ago. I had a limp and severe aches I have found it difficult to stand or walk. Just this week I had an MRI and was diagnosed with a femoral fracture, so I am wandering how bad could the damage be?

    • I can’t really say without examining you and looking at your studies. Femoral fractures or stress fractures vary in severity and treatment options depending on the location of the fracture and other factors.

  2. I’m 51 years old, osteopenia and post menopausal I started a job which requires me to walk 6-8 hours a day on concert. My left leg hurts when I put pressure on it (upper outside) thought it might be my back but it is not improving. With rest leg feels better till I try to walk again.

  3. Sir .
    i have got femur neck fracture dated 1st june and it is oparated on 3rd june2014.Doctor fixed femur head with screw.after six week again x ray report are showing it is not in right positio.so doctor has given complete bed res with some precaution for 3week more.

    please advise me that what will be best treatment in this condition.i will be highly oblidge.

    • I can’t really say without or give you advice without being involved in your care and examining you and reviewing your studies. Generally displaced femoral neck fractures (which are different than the stress fractures I describe in this post) need anatomic alignment and fixation to heal appropriately, since the bone is at risk for nonunion or collapse with loss of blood supply.

  4. 52 year old male. Injury occurred while hill- training for marathon. My MRI results say “T2 sat high signal is seen at the posterior aspect of the femoral head as well as the femoral neck. small curvilinear line of low signal is seen traversing the anterior half of the femoral neck. Stress fracture incomplete left femoral neck with surrounding bone marrow edima. Minimal joint effusion of left hip.

    is this a likely candidate for non-surgical recovery or surgical recovery (screws) What are the indicators of successful non-surgical recovery? (I have another MRI in 4 weeks).

    I am on crutches and am sitting or lying most of the time but bathroom use and certain other minimal activities result in me putting weight on the leg. How bad is that for successful non-surgical recovery?

    • Dan, I can’t give you specific advice since I am not involved in your care. Generally femoral neck stress fractures on the inferior (compression) side do not need surgery. They are usually treated by making a patient strictly nonweightbearing until it heals. Healing can be determined by evidence of bone formation on x-rays or MRI. Stress fractures on the superior (tension) side often need surgical fixation.

  5. Hi, Dr. Geier,
    I’m a 51 year old female runner. Though I run slow, I’ve run several half marathons in years past. Recently while training for a half I increased my distance and speed rapidly and began experiencing pain in my groin area, deep inside. It’s become increasingly bothersome and I’ve had to stop running for a week or two. A few days ago, I stepped in a 6 inch deep hole outside. I felt immediate pain in my hip/groin, and after several days I am almost unable to bear weight on that side at all. My question is, can something sudden, like stepping in a hole, cause an injury like that if there is a niggling problem there to begin with?

    • I can’t say specifically in your case, but a sudden force or stress can create a stress fracture when only a stress reaction was there before.

  6. Hello Dr. Geier,

    17 year old vegetarian runner, volleyball player, and dancer. I was diagnosed three months ago with a compressional fracture in my right femoral neck from running. My Dr put me on crutches immediately. I was working on physical therapy recently to gradually be taken off of my crutches, until I got my most recent MRI which revealed that it hadn’t gotten better at all and, in fact, has gotten worse. I take vegetarian dietary supplements and calcium supplements. Is there ANYTHING I could be missing that wouldn’t be allowing it to heal? And do you think pins will work so I don’t have to get a partial hip replacement?

    • I can’t know what factors were involved in your case, but your orthopaedic surgeon might have some ideas. Generally femoral neck fractures that are non displaced can be treated with cannulated screws.

  7. I am 37yrs old male suffering from stress fracture a small linear hypointesty is seen along the inferomedial cortex of the base of the neck of femur with surrounding altered signal intensty area extending into the lesser trochanter .this appears hyper intense on T2 and STIR images and hypointense on T1 weighted image (MRI READING) still I am doctor may I check patient with sitting position ?almost I am in lydown position near about 16 hrs per day I was completed 3 weeks I feel pain is increase while sitting on chair

    • I would definitely ask your orthopaedic surgeon who can look at those studies and give you advice. As you mention, we generally recommend strict nonweightbearing to patients with femoral neck fractures in the inferior/compression region.

  8. When referring to non-weightbearing and/or bedrest with compression stress fractures, do you have any concerns about sitting in a chair or in the bed? Likewise, when in bed, are there positions one should specifically avoid (e.g. fracture-side down when side lying or externally rotating & abducting the hip when supine)?

    • I can’t offer specific advice, but in my experience, the few patients I’ve had with compressional sided fractures did well just avoiding all weightbearing. Sitting and lying did not prove to be a problem.

  9. hello sir, i was suffering from stress fracture of neck of femur ( compression side) i was complited 6 week with non weight bearing recent MRI shows healed stress/ fatigue fracture without marrow edima ,just i start toe touch walking , i feel groin pain again but intensity is vary , is this pain is normal? and how long it remain?

  10. Hello,

    Have been preparing for a kickboxing tourney and decided to up running. Went from 0 to 3x/week at 4 miles apiece (4 weeks ago). Hip pain started two weeks ago, mostly on the inner side of hip near groin and down front. Started as sharp pain when I got up from sitting or laying down that resolved itself after a couple hobbling steps. No singular event noted in which I would have injured it. Feels very similar to having to crack the hip but does not resolve. Now still have sharp pain when getting up, but it continues as I walk and also feels very sore. Very dramatic when first rising, is painful enough that I have to really amp myself up to take that first left leg step and exhibit significant limp for 5 steps or so. Pain is more manageable after these steps and thus far have been able to continue training, though at a reduced rate. Have ceased all running activity for over a week, and have not been training for the past 3 days. Normally train between 9-12 hours per week. Does this sound like a femoral neck fracture? I have an ortho appt in 3 days, but I would be unwilling to continue to train if it could be one of these fractures. Thank you!

  11. Hi Dr. Geier. I’ve been diagnosed with a mild compression stress fracture in my femoral neck, and I’ve been advised to keep weight off of the leg. Just because I don’t have an immediate line of communication to my doctor, I’m wondering if you can answer a few related questions — Does “non weight bearing” refer just to standing and walking? Is there any harm in planting the foot of my injured leg firmly on the floor when sitting? Thank you!

  12. I am a menopausal 45 year old, After a year of running on a sore hip ( told is was sciatica) I had an MRI when the pain became severe after a half marathon and found a compression side stress fracture, FAI, and bilateral labral tears. I was only told no running, revisit in 2 months and see pain level. In seven years my bone density has gone from a +1.25 to a -0.7. I am taking Calcium even though technically still in the normal range. I desperately want to get back to running but even these weeks of no running, jumping etc, I limp with pain, using a crutch at work is impossible. Is it time for a reevaluation? 7+ weeks post diagnosis.

  13. Hi Doctor,

    I was going through the pain in left leg while walking from last 3-4 months. I got MRI done for left Hip. The MRI report says “features suggestive of stress fracture involving the left femoral neck”. I have been advised by doctor for complete bed rest for 3 weeks. I only get up from bed for bathroom use and certain other minimal activities. Will this 3 weeks rest with small disturbances actually help in healing the fracture? Please explain in detail what is that my MRI report says.

  14. Hello Dr. Geier,

    I first had pain I thought was a muscle pull from cross country skiing for the first time in my life; however, six weeks later an MRI revealed a moderate compression side femoral neck stress reaction. I was a 40 year old active woman, and my questions are:
    1) since it took awhile to be diagnosed, will my recovery be longer and/or am I at greater risk of it not healing at all (doctor has mentioned surgery?!)?
    2) should I be completely nonweight bearing for six weeks even though it’s just a stress reaction?
    3) if I feel the tug in my groin while just sitting or a throbbing at injury site, is this an indication it hasn’t healed and should remain no weightbearing?
    4) should I feel nothing in groin, thigh/knee/buttock before even attempting exercise bike?
    5) could falling really hard onto hard ice several times while skiing down medium hills contribute to this injury (noticed symptoms soon after). I didn’t have a bruise on my hip, my I had a huge one on my upper arm that too weeks to heal from the impacts.

    It is so difficult to gauge if I’m getting better. My doctor doesn’t do follow up MRI and only goes by symptoms, so I am hoping to not hurt it worse by ignoring warning signs. Any help would be greatly appreciated, as this is a scary injury considering the long recovery and having to care for my young children :).

  15. I am 21 year old female I have a grade 3 stress fracture of the right compressive femoral neck, and low-grade strain of bilateral gluteus medius muscle. I have sever pain and can barely walk. I’m in the ARMY and I have had this going for almost 7 weeks now. Am I going to have to get surgery?

  16. Hey Doc, when i was 5 i was diagnosed with Perthes in my right hip, never had surgery(coudlnt afford) but had cast and splint for 6 weeks and then a couple years in braces with the bar between my knees. Im 29 now, and just had my first xray in 23 years. The last 14 of which I have been an aspiring stunt performer and a self taught acrobat, tumbler and breakdancer. The xray shows i have a stress fracture along the femoral neck, and the femoral head itself, in size is 50% of what it should be. I can still perform and do my acrobatics but im noticing more and more pain and loss of range of motion. I do not think its just the recent stress fracture, but rather Perthes catching up fast. I know im too young for surgery but I badly want it anyways because I know I still have so many strong years left and its been my dream to get into films through stunts. I know that I may be an anomoly but thats why I need to try. Is there any advice you could offer? I will never stop chasing my dream, i just feel like its time for me to finally ask for help. Can a surgery be done to cap my femoral head with implant to return me to full mobility? Perthes is crippling me fast and dont know what to do. I would be happy to send my xrays, or even travel to seek your expertise on the matter.
    I appreciate any advice you can offer, unless of course you advise I give up my dream.

    • I am probably the wrong type of surgeon for you. You should seek out a joint replacement orthopaedic surgeon. Good luck!

  17. Hi, I’m 21, female, and have osteopenia. I had a bone density scan done July 2015 when I was 20, but my Dr. never got the results. I’ve only seen her once after that. It was until I went to the hospital a couple of months ago to request my medical records that I found out I have osteopenia on both of my hips.

    My first question is: can osteopenia worsen in a year and half? (I didn’t know I had it, so I did nothing to try to make it better)

    And finally, I’d like to know if there’s a possibility that I may have a stress fracture? I hate going to hospitals and seeing doctors, especially when there’s nothing wrong with me and I just end up wasting their precious time. But I have been feeling extreme pain on both of my hips and lower back. If I apply pressure to my left hip, my entire leg goes numb after a second of horrible pain, and usually the pain radiates to my groin, the back of my thigh, and in very bad days to my abdomen (not as in a stomach ache, but as in like a knot on the left side of my abdomen which can make me nauseous). The pain in my lower back is debilitating, and I can’t sit down for long periods of time because it gets worse, along with the pain on my hips. Some days when I wake up, my left leg is completely numb or feels very very light and weak and it takes some time and effort to be able to stand up and walk. Often, I limp when this happens.

    I’m sorry for such a long post; I just want to know if the pain is normal or not. I’ve suffered from chronic pain since childhood, and it was always embarrassing whenever a doctor would tell me that there was no medical reason for me to feel pain. I always felt they thought I was crazy and making things up to call attention. So I just stopped talking about the pain. But the pain I feel know is more severe than the regular one I feel.

    I would be eternally grateful to you if you could answer my questions.

  18. Hello. I am 49 year old Labor and Delivery Nurse.

    I was rear ended by a big rig, that was texting, and he pushed me down the freeway into and up unnderthe 4×4 custom lifted bronco. My SUV, totalled, but the frame of my car crunched around my left side, and something hit my left knee, and jammed my femur into my pelvis. it felt like my femur neck was pushed up out of socket and since then locked in that position the past month and half.
    And so debilitating, I literally could not walk without limping and crying in pain. Until 2 nights ago. Now my Xrays show radiolucent line on femoral neck and MRI of my knee is torn cartilage from impact. I’m scheduled for contrast dye MRI in 2 days for my hip/femur.

    Now 2 nights ago I was walking my dog, and she chased a cat up a tree, and she’s very strong, so she jerked leash really hard yanking me forward with my foot planted on the ground. And yesterday was the first day in the last month and half I was able to actually walk without holding onto to something.

    I still have the deep groin pain and knee gives out and sheep pain at random times but that’s bearable and I hoping I can go back to work but my question is today, when I woke up, it feels like my femur wants to pop back out of place like it was. I really don’t want it to happen. Is there something I can do to keep that from happening. It’s in the right place now. How do I keep it there?

  19. I have a 16 year old daughter complaining of lower back pain when she sleeps only for the last 2 + years. She plays volleyball and has had an Xray and MRI. Both showed no stress fracture how ever she has 3 compressed vertebra (L3, L4 & L5) which is getting decompressed. She then was referred to an orthoneuro doc and he is ordering a SPECT scan which we have scheduled. He does not see a stress fracture but because she is a girl and 5’8″ and her growth plates are open in the hip joints that is why he ordered the SPECT scan. Could her lower back be from those hip joints still open?

  20. I have just started a new track season. I have been running in gym but not as intensely as I am in track. I have started feeling pain in my left hip that ranges from my groin area to the back of my hip. The pain will come and go when I’m not active but when I start running and being active it will start hurting again. I’m wondering if it’s a stress fracture, and if I should go into the doctor or if I just need to keep icing it? I personally think it may be a stress fracture as I have been doing a lot of reading on the pain I am feeling. Should I go to the doctor or should I just ice it?

  21. I had a femoral neck stress fracture on my right side 5 years ago. I recently started to train for a half marathon. This past weekend I developed pain on my left side during a 10 mile run. On Monday, I couldn’t bear any weight. It has eased some but it feels very similar to my last stress fracture. What is the likelihood that this could happen a second time?

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