A femoral neck stress fracture is a stress fracture of the proximal femur at the hip that most commonly occurs in runners or other athletes who perform repetitive impact to the lower extremities. Athletes often complain of increasing hip and groin pain during runs that begins to take longer to go away. Treatment depends on where the injury occurs. These are serious injuries, so physicians will often place the patient on crutches and make the patient completely non-weight bearing. Fractures of the superior aspect of the femoral neck require surgical treatment, where the surgeon places screws into the femoral neck to compress the fracture and get it to heal.
Signs and symptoms
Femoral neck stress fractures 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.
Diagnosis of a femoral neck stress fracture
A doctor’s physical examination will demonstrate pain in the groin and pain with range of motion. 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. Often a bone scan or an MRI is needed to make the diagnosis, as the x-ray might not demonstrate the stress fracture in the first few weeks that a patient has pain.
Treatment of a femoral neck stress fracture
Treatment of a femoral neck stress fracture depends on where the injury occurs (see arrows on the image). On the lower side of the femoral neck, treatment without surgery is often successful. Due to the risk of poor healing and potential fracture, many sports medicine physicians 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. In this area, the stress fracture often does 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 such as sports and exercise are restricted or limited until the fracture heals. Often being completely nonweightbearing is necessary for many weeks. A doctor might hold a patient out of sports for three to four months. While the recovery and healing process is lengthy, often return to sports is uneventful once healing occurs.
Additionally, orthopedic surgeons often try to identify the reasons the stress fracture occurred. Often a referral for an evaluation for osteoporosis with bone density screening for patients at risk.
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