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Melero-Pardo AL, Pimentel-Soler TC, Benitez-Colón CR. Uncommon Twist: Femoral Neck Stress Fracture in a High-Performance Athlete With an Incidental Diagnosis of Femoroacetabular Impingement. Cureus 2024; 16:e59224. [PMID: 38807826 PMCID: PMC11132732 DOI: 10.7759/cureus.59224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/30/2024] Open
Abstract
Femoral neck stress fractures (FNSFs) are rare but significant injuries, often leading to delayed diagnosis due to nonspecific symptomatology. This case report presents a 30-year-old professional surfer who experienced acute groin pain during a half marathon, ultimately diagnosed with a left intertrochanteric line femur stress fracture and with femoroacetabular impingement (FAI) in the opposite hip. Despite being physically fit, his presentation challenges the prevailing notion that FNSFs predominantly occur in military personnel or the elderly. The patient underwent surgical left hip osteosynthesis without complications. This case highlights the importance of early suspicion of FNSFs in young, active individuals and emphasizes the need for comprehensive evaluation to prevent complications like osteonecrosis and malunion. It underscores the value of a broad differential diagnosis and timely intervention in optimizing outcomes, especially in the context of rising high-impact sports participation.
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2
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Khired ZA. A Case of a Young Military Officer with Bilateral Simultaneous Femoral Neck Stress Fracture. Int Med Case Rep J 2024; 17:131-135. [PMID: 38404752 PMCID: PMC10887935 DOI: 10.2147/imcrj.s411460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/04/2023] [Indexed: 02/27/2024] Open
Abstract
Stress fractures of the femoral neck are rare in young adults and usually happen when the bone is repeatedly put under a lot of stress or because of a bone disease. The incidence of stress fractures is a major health concern for soldiers. Most often, stress fractures affect the metatarsals and tibias, while injuries to the femoral neck are less common. Exertional groin or anterior thigh discomfort that develops gradually over time is often vague and subtle; therefore, a high index of clinical suspicion is indicated. In most cases, the first radiographs will be normal. In order to properly diagnose a stress fracture in the femur, a CT scan is very helpful. Because most femoral neck fractures are not displaced when patients present with them, a diagnosis is often delayed. In conclusion, new military soldiers feeling hip pain should have a thorough medical evaluation to establish an early diagnosis and prevent any consequences.
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Affiliation(s)
- Zenat Ahmed Khired
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
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3
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Yang K, Sambandam S, Yan MJ, Huo M. Femoral neck stress fracture return to activity and the effect of metabolic dysfunction on recovery: A systematic review. J Orthop 2023; 43:79-92. [PMID: 37545869 PMCID: PMC10400407 DOI: 10.1016/j.jor.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
Background Femoral neck stress fractures are rare fractures traditionally found in athletes and military personnel. There is limited literature on return to activity. Objectives To report return to activity rates and times, and long-term outcomes for femoral neck stress fractures reported in the literature. To examine the effects of bone metabolic dysfunction and surgical management on return to activity following FNSF. Research design & methods A systematic literature review of case reports and case series on adults with femoral neck stress fracture that were diagnosed by gross fracture line on X-ray or gold-standard diagnosis with MRI was conducted. Initial search was limited to articles published from January 1997 to Jan 2023 listed in Medline, Embase, and Scopus. Additional articles were manually added via search of retained paper sources. Patient demographics, fracture type, return to activity time, and surgical vs non-surgical treatment modality were collected. In addition, long-term outcomes and metabolic effects, if reported, were abstracted. Results A total of 40 case reports or case series were retained. 123 stress fractures of the femoral neck from 103 patients were compiled. Of the 103 patients, data on return to activity at least one year following treatment was available for 53 patients. 71% (37/53) of those with long-term follow-up information returned to full pre-injury activity. 24% (13/53) at long-term follow-up had functional recovery but did not return to pre-injury activity due to residual pain. 4% (3/53) had disabling pain. Metabolic workup information was available for 36 patients. Conclusion Long-term follow-up and return to activity information following FNSF treatment are not commonly reported. Based on the available data, outcomes appear benign with most returning to full activity. There is a clear need for standardization of follow-up periods and hip function measure after FNSF treatment. Additionally, a sizable proportion of FNSF occurred in a new population of low-activity individuals with abnormal bone metabolism, which warrants further exploration.
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Affiliation(s)
- Kristine Yang
- University of Texas Southwestern Medical Center, Dept. of Orthopaedic Surgery, United States
| | - Senthil Sambandam
- University of Texas Southwestern Medical Center, Dept. of Orthopaedic Surgery, United States
- Veteran's Affairs North Texas Health Care System, Dept. of Orthopaedic Surgery, United States
| | - Matthew J. Yan
- David Geffen School of Medicine, University of California Los Angeles, United States
| | - Michael Huo
- University of Texas Southwestern Medical Center, Dept. of Orthopaedic Surgery, United States
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4
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Weinrich L, Dahne M, Lindner T, Stöckle U, Tsitsilonis S. Femoral Neck Stress Fracture of a Male, Healthy Marathon Runner - Case Report and Literature Review. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:564-571. [PMID: 33782932 DOI: 10.1055/a-1401-0375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the present report, a case of a healthy, 38-year-old male recreational marathon runner who presented in the emergency department is discussed. He was diagnosed with a stress fracture of the femoral neck and treated surgically using a dynamic hip screw (DHS). One year after surgery, the patient was able to return to most of his previous sports activities. In the present report, the existing literature on the subject is exhibited and the points of interest in terms of incidence, risk factors, diagnosis, classification, treatment, and long-term outcome are analyzed. We suggest operative treatment of stress fractures of the femoral neck even in cases of complete undisplaced ones. This way, the risk of a displacement is counteracted, and patients can quickly return to daily activities without having to withstand long-term immobilization.
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Affiliation(s)
- Luise Weinrich
- Centrum für Muskuloskeletale Chirurgie, Charité University Hospital Berlin, Germany
| | - Michael Dahne
- Centrum für Muskuloskeletale Chirurgie, Charité University Hospital Berlin, Germany
| | - Tobias Lindner
- Zentrale chirurgische Notaufnahme, Charité University Hospital Berlin, Germany
| | - Ulrich Stöckle
- Centrum für Muskuloskeletale Chirurgie, Charité University Hospital Berlin, Germany
| | - Serafeim Tsitsilonis
- Centrum für Muskuloskeletale Chirurgie, Charité University Hospital Berlin, Germany
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5
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Shaw KA, Hattaway J, Villani N, Barkley C, O’Brien F, Jackson KL, Tucker M. Surgically Treated Femoral Neck Stress Fractures Are Likely to Result in Military Separation During Basic Combat Training. Clin Orthop Relat Res 2022; 480:1684-1691. [PMID: 35319514 PMCID: PMC9384903 DOI: 10.1097/corr.0000000000002187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/07/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoral neck stress fractures are a common condition affecting military service members, most noticeably during basic combat training. Previous studies have investigated the risk factors for femoral neck stress fracture development in basic trainees and outcomes associated with treatment; however, few studies have focused on operatively treated femoral neck stress fracture in the military trainee. Doing so would be important not only for the military, but also providers caring for athletes, such as distance runners, who have a heightened risk for femoral neck stress fracture development. QUESTIONS/PURPOSES (1) What proportion of US Army trainees completing basic combat training at Fort Jackson, SC, USA, who undergo surgery for femoral neck stress fracture during basic training subsequently leave military service because of the injury? (2) What factors are related to the patient or the fracture are associated with a higher likelihood of military separation? (3) What factors on the initial MRI are associated with progression of the stress fracture extent? METHODS A retrospective study of a longitudinally maintained database of stress injuries involving basic combat trainees from a single military post was reviewed over a 3-year period. Inclusion criteria included basic trainees undergoing surgery for a femoral neck stress fracture between January 2018 and June 2020 with a minimum of 1-year follow-up. Surgery was indicated for service members with complete and tension-sided femoral neck stress fractures and those with high risk compression-sided stress fractures, generally representing fractures involving more than 50% of the femoral neck width. Over the study period, 57 service members (51% [29 of 57] women with a mean age of 24 years) underwent surgery for a femoral neck stress fracture, and all 57 had a minimum of 1-year follow-up. Identified service members underwent independent data collection including injury and radiographic parameters based on chart and imaging review. Documented fracture line progression on repeat imaging was present in 39% of service members, with a mean fracture line progression of 55% of the femoral neck width. Service members were subdivided based upon the ability to return to military service at 1 year. Univariate analysis was performed using patient and injury variables to identify factors associated with the ability to return to military service. RESULTS Overall, 58% (33 of 57) of service members who had a femoral neck stress fracture treated surgically underwent military separation. A higher proportion of service members who demonstrated fracture line progression leading to surgical treatment remained in the military (58% [14 of 24] versus 30% [10 of 33]; odds ratio 0.3 [95% confidence interval (CI) 0.1 to 0.9]; p = 0.03). With the numbers available, we found no other patient- or fracture-related variables associated with military separation, although we suspect we may have been underpowered on some of these comparisons, in particular gender (61% [20 of 33] of individuals separated after surgery for this injury were women compared with 38% [9 of 24] who were retained; OR 2.6 [95% CI 0.9 to 7.56]; p = 0.09). The extent of osseous edema on T1-weighted imaging in association with a hip effusion demonstrated a significant positive correlation with final fracture percentage (r = 0.62; p = 0.003). CONCLUSION Military service members with a femoral neck stress fracture initially managed nonoperatively but with progression of the fracture line requiring surgical intervention were more likely to return to military duties and complete basic combat training, suggesting that early diagnosis of femoral neck stress fractures may be associated with better functional recovery after surgical treatment. Additionally, the extent of the osseous edema on initial MRI T1-weighted imaging sequences may help predict the final extent of femoral neck stress fractures on repeat imaging. Further investigations should incorporate patient-reported outcomes and further explore factors associated with fracture progression and the inability to return to active duty or sport. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- K. Aaron Shaw
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Joshua Hattaway
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Nolan Villani
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Colleen Barkley
- Department of Physical Therapy, Moncrief Army Community Hospital, Columbia, SC, USA
| | - Frederick O’Brien
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Keith L. Jackson
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Michael Tucker
- Department of Orthopaedic Surgery, Prisma Health Richland Hospital, Columbia, SC, USA
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6
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Holtzman B, Popp KL, Tenforde AS, Parziale AL, Taylor K, Ackerman KE. Low energy availability surrogates associated with lower bone mineral density and bone stress injury site. PM R 2022; 14:587-596. [PMID: 35460534 DOI: 10.1002/pmrj.12821] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Exercise is an osteogenic stimulus that should increase bone mineral density (BMD) and protect against injury. However, some female athletes have lower BMD and increased bone stress injury (BSI) risk. Impaired bone health seen in athletes may be explained by low energy availability as described by concepts of Relative Energy Deficiency in Sport (RED-S) and Female Athlete Triad (Triad). OBJECTIVE To elucidate the relationship between RED-S/Triad risk factors and BSI to high-risk (femoral neck, sacrum) and low-risk (other) bones. DESIGN Cross-sectional survey and retrospective chart review. SETTING Tertiary care academic center. PATIENTS Female athletes aged 15-30 years participating in ≥4 h/week of exercise presenting to sports medicine/orthopedics clinic who had a self-reported BSI and available dual-energy x-ray absorptiometry (DXA) measurement of BMD. INTERVENTIONS Not applicable. MAIN OUTCOME MEASUREMENTS Location of BSI. RESULTS In 127 athletes, high-risk BSI was associated with surrogates of low energy availability (p = .032) and having a DXA Z-score < -1 (p = .035) but not a current/past history of menstrual dysfunction (p = .348). Accumulating RED-S/Triad risk factors increase the odds of incurring a high-risk BSI (p = .048). CONCLUSIONS Adolescent/young female athletes who sustain BSI at high-risk sites (femoral neck, sacrum) may have underlying risk factors (eg, low energy availability, poor overall bone health) that should prompt further workup and referral to optimize health in these athletes.
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Affiliation(s)
- Bryan Holtzman
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kristin L Popp
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States.,Endocrine Division, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Adam S Tenforde
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Allyson L Parziale
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, United States
| | - Kathryn Taylor
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Kathryn E Ackerman
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States.,Endocrine Division, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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7
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SUNDKVIST J, MÖLLER M, ROGMARK C, WOLF O, MUKKA S. Stress fractures of the femoral neck in adults: an observational study on epidemiology, treatment, and reoperations from the Swedish Fracture Register. Acta Orthop 2022; 93:413-416. [PMID: 35417029 PMCID: PMC9007069 DOI: 10.2340/17453674.2022.2460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Stress fractures of the femoral neck (sFNFs) are uncommon injuries. Studies on sFNFs are rare. We describe the demographics, classification, treatment, reoperation rates, and mortality in a cohort of sFNF patients from the Swedish Fracture Register (SFR). PATIENTS AND METHODS We included 146 patients ≥ 18 years of age with an sFNF registered in the SFR between 2011 and 2020. The cohort was linked with the Swedish Arthroplasty Register and reviewed using medical records and radiographs. We assessed the presence of disorders of bone remodeling, duration of symptoms, fracture classification, treatment, reoperations, and mortality. RESULTS The mean age was 58 years (21-96), 75% were women and the median duration of symptoms was 23 days (1-266). 40% of patients had disorders of bone remodeling. 54% were undisplaced (uFNF), 30% displaced (dFNF), and 16% basicervical (bFNF). 14% of patients < 60 years were treated nonoperatively, by internal fixation (IF) in 77% and by arthroplasty in 10%. Patients ≥ 60 years were treated nonoperatively in 10%, IF in 40%, and arthroplasty in 49%. Nonoperative treatment was reserved for uFNFs or bFNFs, resulting in 35% receiving late surgery. The overall secondary or late surgery rate was 19%. Mortality was 2% at 90 days and increased to 3% at 1 year. INTERPRETATION sFNF has a biphasic age distribution. One-third of patients presented with a displaced FNF and those managed nonoperatively for an undisplaced sFNF were at risk of late surgery. The mortality rates for patients with these injuries was low.
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Affiliation(s)
- Jonas SUNDKVIST
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University
| | - Michael MÖLLER
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg
| | - Cecilia ROGMARK
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö
| | - Olof WOLF
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Sebastian MUKKA
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University
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8
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Shaw KA, Moreland CM, Hunt TJ, Barkley C, O'Brien F, Jackson KL. Femoral Neck Stress Fractures in Athletes and the Military. J Bone Joint Surg Am 2022; 104:473-482. [PMID: 35234724 DOI: 10.2106/jbjs.21.00896] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Femoral neck stress fractures (FNSFs) are an infrequent condition in athletic and military populations. ➤ A high index of suspicion with liberal use of magnetic resonance imaging (MRI) is vital for early recognition and treatment initiation. ➤ An associated hip effusion on MRI is a risk factor for an evolving stress injury and requires close assessment and consideration for repeat MRI. ➤ Stress reactions and stable, incomplete FNSFs (<50% of femoral neck width) can be treated nonsurgically. ➤ Surgical intervention is accepted for high-risk, incomplete (≥50% of femoral neck width), and complete FNSFs. ➤ Overall, there is a paucity of high-quality literature on the rates of return to activity following FNSF.
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Affiliation(s)
- K Aaron Shaw
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Colleen M Moreland
- Department of Orthopaedic Surgery, Womack Army Medical Center, Fort Bragg, North Carolina
| | - Tyler J Hunt
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Colleen Barkley
- Department of Physical Therapy, Moncrief Army Health Clinic, Fort Jackson, South Carolina
| | - Frederick O'Brien
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Keith L Jackson
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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9
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Nadwodny JP, Pujalte G, Bertasi TGDO, Huff T. Intertrochanteric hip stress fracture in a male ultramarathon runner. BMJ Case Rep 2022; 15:e239594. [PMID: 35027376 PMCID: PMC8762139 DOI: 10.1136/bcr-2020-239594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/04/2022] Open
Abstract
Stress fractures are injuries frequently seen in high-performance athletes, especially runners. In the femur, the most commonly affected locations are the femoral neck, condylar area and proximal shaft. Intertrochanteric fractures are much more common in the elderly population, especially among those with osteoporosis, but they can also be a result of high-energy repetitive mechanisms. We present a case of an intertrochanteric stress fracture in a young male runner. The diagnosis was suspected after persistent pain following his first marathon, and it was confirmed with an MRI. Operative fixation of the fracture was performed 22 days after the pain started, which allowed the patient to return to his activities, including 50 km marathon 4 months following the surgery.
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Affiliation(s)
| | - George Pujalte
- Family Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Tamara Huff
- Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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10
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Gerstmeyer JR, Godolias P, Mempel E, Bernstorff M, Schildhauer TA, Königshausen M. [Femoral neck stress fracture in a young runner - a rare but severe injury]. SPORTVERLETZUNG-SPORTSCHADEN 2022; 36:60-63. [PMID: 35016242 DOI: 10.1055/a-1554-4309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A 29-year-old athlete suffered from vague hip pain during the preparation for a marathon competition. During the competition, severe pain forced him to drop out after 29 kilometres. He underwent conventional x-rays immediately, which showed a displaced lateral fracture of the femoral neck. The fracture was immediately treated with a dynamic hip screw. A few days later, the patient was discharged. He returned to sport upon completion of treatment. Vague hip pain after exercise may be an indicator for a rare stress fracture of the femoral neck and should be taken into consideration in athletes. Delayed diagnostic investigation and treatment reduce return-to-sport rates and outcomes.
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Affiliation(s)
| | - Periklis Godolias
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, GERMANY
| | - Eileen Mempel
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, GERMANY
| | - Maria Bernstorff
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, GERMANY
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11
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Sundkvist J, Brüggeman A, Sayed-Noor A, Möller M, Wolf O, Mukka S. Epidemiology, classification, treatment, and mortality of adult femoral neck and basicervical fractures: an observational study of 40,049 fractures from the Swedish Fracture Register. J Orthop Surg Res 2021; 16:561. [PMID: 34526047 PMCID: PMC8442466 DOI: 10.1186/s13018-021-02701-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although femoral neck fractures (FNFs) are common in orthopedic departments, optimal treatment methods remain in dispute. There are few large nationwide studies, including basicervical FNFs (bFNFs), on epidemiology, treatment, and mortality. This nationwide study aims to describe the epidemiology, fracture classification, current treatment regimens, and mortality of undisplaced and minimally displaced (Garden I-II, uFNF), displaced (Garden III-IV, dFNF) and bFNFs in adults. METHODS All FNFs, including bFNFs with a registered injury date between 1 April 2012 and 31 December 2020, were included in this observational study from the Swedish Fracture Register (SFR). Data on age, sex, injury mechanism, fracture classification, primary treatment, and seasonal variation were analyzed. RESULTS Some 40,049 FNFs were registered in the SFR. The mean age of the patients in the register was 80.3 (SD 11) years and 63.8% (25,567) were female. Of all FNFs, 25.0% (10,033) were uFNFs, 63.4% (25,383) dFNFs, and 11.6% (4,633) bFNFs. Non-surgical treatment was performed in 0.6% (261) of the patients. Internal fixation (IF) (84.7%) was the main treatment for uFNFs and arthroplasty (87.3%) for dFNFs. For bFNFs, IF (43.8%) and hip arthroplasty (45.9%) were performed equally often. Of the 33,105 patients with a 1-year follow-up mortality at 1-year was 20.6% for uFNF, 24.3% for dFNF, and 25.4% for bFNF. CONCLUSION The main treatment of uFNFs is IF with screws or pins. Hip arthroplasty is the predominant treatment for dFNF. bFNF are more common than previously reported and treated with IF or arthroplasty, depending on patient age. These results may help health care providers, researchers and clinicians better understand the panorama of FNFs in Sweden. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Jonas Sundkvist
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden.
| | - Anders Brüggeman
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Arkan Sayed-Noor
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Olof Wolf
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden
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12
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Nam DC, Hwang SC, Lee EC, Song MG, Yoo JI. Femoral neck stress fractures after trampoline exercise: A case report. World J Clin Cases 2021; 9:4783-4788. [PMID: 34222448 PMCID: PMC8223852 DOI: 10.12998/wjcc.v9.i18.4783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/17/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Femoral neck stress fractures (FNSFs) are commonly found in long-distance running athletes. For FNSFs, early diagnosis and proper treatment are important. The objective of this study was to report FNSFs that occurred after excessive exercise using trampoline in middle-aged women.
CASE SUMMARY The patient was a 43-year-old woman who exercised jumping on a trampoline for 6 wk for 1-3 h a day to diet. Exercise includes repeated flexion-extension of the hip joint. The patient was admitted to the hospital due to sudden bilateral groin pain that occurred suddenly during a trampoline exercise. Hip magnetic resonance imaging (MRI) revealed bilateral FNSFs. After 2 wk of follow-up with conservative treatment, the pain slightly decreased. However, it did not disappear completely. It was determined that it was difficult to control symptoms only by conservation treatment. Thus, closed reduction and internal fixation using a cannulated screw were performed for the more painful left hip joint. After operation, the pain was improved. Walking using crutches was possible. Follow-up MRI showed that the right femoral head signal was decreased compared to the left femoral head signal. Therefore, nonsteroidal anti-inflammatory drug and conservative treatment were provided.
CONCLUSION In middle-aged people, excessive trampoline exercise can repeat hip flexion and extension for a short period of time, leading to FNSFs.
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Affiliation(s)
- Dae Cheol Nam
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju 52727, South Korea
| | - Sun Chul Hwang
- Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Eun Chang Lee
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju 52727, South Korea
| | - Myung-Geun Song
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju 52727, South Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju 52727, South Korea
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Singh D, Dhammi IK, Jain A, Shahi P, Kumar S, Bansal K. Osteosynthesis in femoral neck fracture in two patients with ipsilateral lower limb amputation. BMJ Case Rep 2021; 14:14/3/e239060. [PMID: 33766963 PMCID: PMC8006772 DOI: 10.1136/bcr-2020-239060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Femoral neck fracture in lower limb amputees poses treatment problems. The altered biomechanics of the hip in amputees, stump length, associated osteoporosis and difficulty in positioning these patients on the operation table are few of the technical challenges faced by an operating surgeon especially while salvaging the native hip joint. We report a case series of two lower limb amputee patients with fracture neck of femur in whom we salvaged the native hip joint by performing osteosynthesis. We observed satisfactory results of osteosynthesis in both of our patients on follow-up, with both achieving pretrauma ambulatory status in 6-8 weeks postoperatively. We concluded that each lower limb amputee patient with fracture neck of femur should be carefully evaluated on presentation and managed individually. These patients can be positioned and managed by osteosynthesis on a standard operating table or fracture table without requiring any special operating theatre set-up (traction devices).
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Affiliation(s)
- Deepak Singh
- Orthopaedics, University College of Medical Sciences, Delhi, Delhi, India
| | - Ish Kumar Dhammi
- Orthopaedics, University College of Medical Sciences, Delhi, Delhi, India
| | - Archit Jain
- Orthopaedics, University College of Medical Sciences, Delhi, Delhi, India
| | - Pratyush Shahi
- Orthopaedics, University College of Medical Sciences, Delhi, Delhi, India
| | - Saurabh Kumar
- Orthopaedics, University College of Medical Sciences, Delhi, Delhi, India
| | - Kuldeep Bansal
- Orthopaedics, University College of Medical Sciences, Delhi, Delhi, India
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Stress Fractures of the Hip and Pelvis. Clin Sports Med 2021; 40:363-374. [PMID: 33673892 DOI: 10.1016/j.csm.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Stress fractures refer to overuse injuries of bone resulting from repetitive mechanical stress. Stress fractures of the hip and pelvic region, while relatively uncommon, have become increasingly recognized in certain populations, particularly long-distance runners and military recruits. The diagnosis of such injuries can be challenging, often hampered by a nonspecific physical examination and limited sensitivity of plain radiography. Early recognition is important to direct appropriate management, lessen time lost from sport, and avoid potential complications. The present article reviews the epidemiology, diagnosis, and management of bone stress injuries of the hip and pelvis, specifically the sacrum, pubic ramus, and femoral neck.
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Yoshida N, Tsuchida Y, Murakami H, Shirakawa T, Futamura K, Kohzuki M. Time-Dependent Magnetic Resonance Imaging Changes in Occult Femoral Neck Fracture During Conservative Treatment: A Case Report. JBJS Case Connect 2020; 10:e0570. [PMID: 32224676 DOI: 10.2106/jbjs.cc.19.00570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 53-year-old woman presented to the emergency department with persistent left hip pain after a fall while riding a bicycle. Although x-ray imaging revealed no evidence of fracture, an abnormal intensity vertical line along the left femoral neck was observed in the magnetic resonance imaging (MRI). Furthermore, 2 weeks after injury, MRI revealed a newly developed abnormal intensity oblique band at the femoral neck. After discussing several treatment options with the patients, she chose the conservative treatment. CONCLUSION Careful follow-ups and MRI were undertaken 6 times within 32 weeks. Bone union was observed 32 weeks after the injury, and no bone displacement was observed.
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Affiliation(s)
- Naoki Yoshida
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yoshihiko Tsuchida
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroko Murakami
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Tetsuya Shirakawa
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kentaro Futamura
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
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Jasqui-Remba S, Jasqui-Bucay A, Jasqui-Bucay A, Fernández-De-Lara-Barrera Y. Bilateral femoral neck stress fractures in a high-performance young female runner. BMJ Case Rep 2019; 12:12/8/e230900. [PMID: 31451476 DOI: 10.1136/bcr-2019-230900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A 16-year-old female patient showed up at the orthopaedics unit complaining of intolerable pain on her left hip. While being questioned and her clinical history written down, she shared that as part of her daily exercise routine, she ran 10 miles (16 km) daily at a speed of 9.5-10.5 mph (15-17 km/hour). MRI was consequently ordered, confirming the presence of a stress fracture. Therefore, immediate suspension of physical activity was indicated, followed by the prescription of crutches as well as restricted weight bearing. Gradually, she recovered complete functionality and approximately a month after she had entirely healed. While on a skiing trip, again she abruptly developed an acute pain on her right hip. Another MRI was ordered; its result confirmed a new stress fracture. Her previous treatment has proved so successful, a conservative approach was once again prescribed for her, showing optimum results 6 months later.
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Affiliation(s)
- Salomon Jasqui-Remba
- Department of Orthopaedic Surgery, American British Cowdray Medical Center, Ciudad de Mexico, Mexico
| | - Alan Jasqui-Bucay
- Department of Orthopaedic Surgery, Hospital Ángeles Lomas, Huixquilucan, Mexico
| | - Ariel Jasqui-Bucay
- Department of Orthopaedic Surgery, Hospital Ángeles Lomas, Huixquilucan, Mexico
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Koaban S, Alatassi R, Alharbi S, Alshehri M, Alghamdi K. The relationship between femoral neck fracture in adult and avascular necrosis and nonunion: A retrospective study. Ann Med Surg (Lond) 2019; 39:5-9. [PMID: 30733863 PMCID: PMC6357682 DOI: 10.1016/j.amsu.2019.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 12/22/2022] Open
Abstract
Background One of the most serious sequelae of femoral neck fractures (FNFs) is avascular necrosis (AVN), and this complication translates to significant morbidity and mortality. This study was conducted to determine the relationship between the etiologies and management of FNFs at our institution and the development of AVN or nonunion. Materials and methods This study was a retrospective medical chart review of all adult patients admitted and managed for FNF. Results There were a total of 69 FNF patients reviewed. FNF was caused by a fall in 37 patients (53.6%), a road traffic accident in 16 (23.2%), motorcycle and motorbike accidents in 8 (11.6%), and heavy exercise in 8 (11.6%). Twenty-four patients (34.8%) had fixation within 24 h of injury, and 45 (65.2%) went more than 24 h before fixation. The mean RUSH score at 6 months was 21.4 ± 5.1. There were 4 patients (5.8%) with a collapsed FNF and 4 patients (5.8%) had a nonunion FNF. AVN was documented in 12 patients (17.4%). Of the 12 patients who had AVN, 8 (66.7%) received fixation within 24 h from the time of the injury, whereas only 4 (33.3%) received fixation more than 24 h after the injury. There was a significant negative correlation between the time of fixation and AVN. Conclusion We report a 17.4% incidence of AVN over 10 years in patients managed with FNF. AVN was found to be significantly correlated with the mode of injury (fall and RTA among younger male patients). Avascular necrosis is a serious sequelae of femoral neck fracture. It has been noted that time is essential in the management of FNFs. We found that there is no association between late fixation of the FNF and the development of AVN.
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Affiliation(s)
- Saeed Koaban
- Security Forces Hospital, Department of Orthopedic Surgery, Riyadh, Saudi Arabia
| | - Raheef Alatassi
- Security Forces Hospital, Department of Orthopedic Surgery, Riyadh, Saudi Arabia
| | - Salman Alharbi
- Security Forces Hospital, Department of Orthopedic Surgery, Riyadh, Saudi Arabia
| | - Mansour Alshehri
- Security Forces Hospital, Department of Orthopedic Surgery, Riyadh, Saudi Arabia
| | - Khalid Alghamdi
- Security Forces Hospital, Department of Orthopedic Surgery, Riyadh, Saudi Arabia
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Smits DW, Backx F, Van Der Worp H, Van Middelkoop M, Hartgens F, Verhagen E, Kluitenberg B, Huisstede B. Validity of injury self-reports by novice runners: comparison with reports by sports medicine physicians. Res Sports Med 2018; 27:72-87. [PMID: 29969569 DOI: 10.1080/15438627.2018.1492399] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examined the criterion validity of self-reported running-related injuries (RRI) by novice runners. Fifty-eight participants (41 females; age 46 ± 11 yrs) of the "Start-to-Run" program provided self-reports on their RRIs using an online questionnaire. Subsequently, they attended injury consultations with sports medicine physicians who provided physician-reports (blinded for the self-reports) as a reference standard. Self-reports and physician-reports included information on injury location (i.e., hip/groin, upper leg, knee, lower leg, and ankle/foot) and injury type (i.e., muscle-tendon unit, joint, ligament, or bone). Sensitivity, specificity, and positive predictive values were 100% for all five injury locations. For injury type, sensitivity was low (66% for muscle-tendon unit, 50% for ligament, and 40% for bone) and lowest for joint injuries (17%). In conclusion, the validity of self-reported RRIs by novice runners is good for injury locations but not for injury types. In particular for joint injuries, the validity of novice runners' self-reports is low. Abbreviations: RRI: Running Related Injury; SMC: Sports Medicine Centre; MTU: Muscle Tendon Unit; PPV: Positive Predictive Value.
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Affiliation(s)
- Dirk-Wouter Smits
- a Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neuroscience , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Frank Backx
- a Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neuroscience , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Henk Van Der Worp
- b Center for Sports Medicine, University of Groningen , University Medical Center Groningen , Groningen , The Netherlands
| | - Marienke Van Middelkoop
- c Department of General Practice , Erasmus MC University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Fred Hartgens
- d Departments of Epidemiology and Surgery, Research School CAPHRI , Maastricht University Medical Center+, and Sports Medicine Center Maastricht , Maastricht , The Netherlands
| | - Evert Verhagen
- e Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research , VU University Medical Center , Amsterdam , The Netherlands.,f Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) , Federation University Australia, SMB Campus , Ballarat , Victoria , Australia
| | - Bas Kluitenberg
- b Center for Sports Medicine, University of Groningen , University Medical Center Groningen , Groningen , The Netherlands
| | - Bionka Huisstede
- a Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neuroscience , University Medical Center Utrecht , Utrecht , The Netherlands
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Fonte H, Rodrigues-Pinto R. Femoral neck stress fracture in a young female recruit: case report. SICOT J 2018; 4:16. [PMID: 29774866 PMCID: PMC5958626 DOI: 10.1051/sicotj/2018011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 03/25/2018] [Indexed: 02/01/2023] Open
Abstract
Introduction: Femoral neck stress fractures are uncommon and depending on their location, can be at high risk for non-union and significant morbidity. Their prevalence is higher among runners and military recruits, and women seem to be at higher risk. Methods: A 27-year-old female, who was enrolled in military recruit, reported left side groin pain after a strenuous running exercise. Due to persistent pain an X-Ray was ordered, which revealed no signs of acute lesions. Further imaging studies with CT scan and MRI identified a compression-type femoral neck stress fracture. Results: The patient was submitted to conservative treatment consisting of restricting from full weight-bearing. Six weeks after she initiated partial weight-bearing, becoming asymptomatic at seven months. Follow-up imaging studies revealed union of the fracture. Discussion: This diagnosis should be considered when evaluating military and athlete populations. Early recognition of these injuries is crucial because complication and morbidity rates are high.
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Affiliation(s)
- Hélder Fonte
- Portuguese Army, Portugal - Centro Hospitalar do Porto, Hospital de Santo António, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Centro Hospitalar do Porto, Hospital de Santo António, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
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Wilk R, Kusz D, Grygiel H, Grosiak M, Kamiński J, Kusz M. Atraumatic femoral neck fracture during bisphosphonate treatment: case report and review of the literature. Aging Clin Exp Res 2017; 30:881-885. [PMID: 29080052 PMCID: PMC6008339 DOI: 10.1007/s40520-017-0846-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/06/2017] [Indexed: 10/24/2022]
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Biz C, Berizzi A, Crimì A, Marcato C, Trovarelli G, Ruggieri P. Management and treatment of femoral neck stress fractures in recreational runners: a report of four cases and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 29083360 PMCID: PMC6357658 DOI: 10.23750/abm.v88i4-s.6800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Femoral neck stress fractures (FNSFs) in healthy young subjects are uncommon and most prevalent among long-distance runners and military recruits. Women seem to be at higher risk of developing stress fractures because of possible eating disorders followed by amenorrhea and osteoporosis. This case report describes four young and middle-aged, active female recreational runners who developed stress fractures of the femoral neck. In three of them, with a clinical history of persistent pain in the groin region, which worsened during training, early diagnosis by MRI was considered essential in detecting the fractures. The patients were clinically, metabolically and radiographically evaluated; they were then treated and followed-up at our institution. Only one case was treated conservatively, while the others underwent surgical internal fixation using a screw-plate (DHS®). All of them returned to sport physical activity after a recovery period. Regarding the challenging management of FNSFs, our report highlights the importance of groin pain, especially in athletic females, an early diagnosis by MRI, and a proper classification of these injuries for a correct choice of treatment in order to prevent further dislocation and avoid avascular necrosis of the femoral head. (www.actabiomedica.it)
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Biz C, Berizzi A, Crimì A, Marcato C, Trovarelli G, Ruggieri P. Management and treatment of femoral neck stress fractures in recreational runners: a report of four cases and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 29083360 DOI: 10.23750/abm.v88i4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Femoral neck stress fractures (FNSFs) in healthy young subjects are uncommon and most prevalent among long-distance runners and military recruits. Women seem to be at higher risk of developing stress fractures because of possible eating disorders followed by amenorrhea and osteoporosis. This case report describes four young and middle-aged, active female recreational runners who developed stress fractures of the femoral neck. In three of them, with a clinical history of persistent pain in the groin region, which worsened during training, early diagnosis by MRI was considered essential in detecting the fractures. The patients were clinically, metabolically and radiographically evaluated; they were then treated and followed-up at our institution. Only one case was treated conservatively, while the others underwent surgical internal fixation using a screw-plate (DHS®). All of them returned to sport physical activity after a recovery period. Regarding the challenging management of FNSFs, our report highlights the importance of groin pain, especially in athletic females, an early diagnosis by MRI, and a proper classification of these injuries for a correct choice of treatment in order to prevent further dislocation and avoid avascular necrosis of the femoral head.
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Biz C, Berizzi A, Crimì A, Marcato C, Trovarelli G, Ruggieri P. Management and treatment of femoral neck stress fractures in recreational runners: a report of four cases and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:96-106. [PMID: 29083360 PMCID: PMC6357658 DOI: 10.23750/abm.v88i4 -s.6800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 12/28/2022]
Abstract
Femoral neck stress fractures (FNSFs) in healthy young subjects are uncommon and most prevalent among long-distance runners and military recruits. Women seem to be at higher risk of developing stress fractures because of possible eating disorders followed by amenorrhea and osteoporosis. This case report describes four young and middle-aged, active female recreational runners who developed stress fractures of the femoral neck. In three of them, with a clinical history of persistent pain in the groin region, which worsened during training, early diagnosis by MRI was considered essential in detecting the fractures. The patients were clinically, metabolically and radiographically evaluated; they were then treated and followed-up at our institution. Only one case was treated conservatively, while the others underwent surgical internal fixation using a screw-plate (DHS®). All of them returned to sport physical activity after a recovery period. Regarding the challenging management of FNSFs, our report highlights the importance of groin pain, especially in athletic females, an early diagnosis by MRI, and a proper classification of these injuries for a correct choice of treatment in order to prevent further dislocation and avoid avascular necrosis of the femoral head.
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Robertson GAJ, Wood AM. Lower limb stress fractures in sport: Optimising their management and outcome. World J Orthop 2017; 8:242-255. [PMID: 28361017 PMCID: PMC5359760 DOI: 10.5312/wjo.v8.i3.242] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/14/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023] Open
Abstract
Stress fractures in sport are becoming increasing more common, comprising up to 10% of all of sporting injuries. Around 90% of such injuries are located in the lower limb. This articles aims to define the optimal management of lower limb stress fractures in the athlete, with a view to maximise return rates and minimise return times to sport. Treatment planning of this condition is specific to the location of the injury. However, there remains a clear division of stress fractures by “high” and “low” risk. “Low risk” stress fractures are those with a low probability of fracture propagation, delayed union, or non-union, and so can be managed reliably with rest and exercise limitation. These include stress fractures of the Postero-Medial Tibial Diaphysis, Metatarsal Shafts, Distal Fibula, Medial Femoral Neck, Femoral Shaft and Calcaneus. “High risk” stress fractures, in contrast, have increased rates of fracture propagation, displacement, delayed and non-union, and so require immediate cessation of activity, with orthopaedic referral, to assess the need for surgical intervention. These include stress fractures of the Anterior Tibial Diaphysis, Fifth Metatarsal Base, Medial Malleolus, Lateral Femoral Neck, Tarsal Navicular and Great Toe Sesamoids. In order to establish the optimal methods for managing these injuries, we present and review the current evidence which guides the treatment of stress fractures in athletes. From this, we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport. Following this, key recommendations are provided for the management of the common stress fracture types seen in the athlete. Five case reports are also presented to illustrate the application of sport-focussed lower limb stress fracture treatment in the clinical setting.
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Robertson GA, Wood AM. Femoral Neck Stress Fractures in Sport: A Current Concepts Review. Sports Med Int Open 2017; 1:E58-E68. [PMID: 30539087 PMCID: PMC6226070 DOI: 10.1055/s-0043-103946] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 12/11/2022] Open
Abstract
Femoral neck stress fractures (FNSFs) account for 3% of all sport-related stress fractures. The commonest causative sports are marathon and long-distance running. The main types of FNSF are compression-sided, tension-sided and displaced. The most common reported symptom is exercise-related groin pain. Radiographs form the first line of investigation, with MRI the second-line investigation. The management of FNSFs is guided by the location and displacement of the fracture. Delay in diagnosis is common and increases the likelihood of fracture displacement. Sporting outcomes are considerably worse for displaced fractures. Education programmes and treatment protocols can reduce the rates of displaced FNSFs. This article aims to provide a current concepts review on the topic of FNSFs in sport, assess the current evidence on the epidemiology and pathophysiology of these injuries, detail the current recommendations for their imaging and management, and review the recorded sporting outcomes for FNSFs in the existing literature. From this study, we conclude that although FNSFs are a rare injury, they should be considered in all athletes presenting with exercise-related hip pain, because delay in diagnosis and subsequent fracture displacement can significantly impair future return to sport. However, when detected early, FNSFs show promising results in terms of return-to-sport rates and times.
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Affiliation(s)
- Greg A Robertson
- Edinburgh Orthopaedic Trauma Unit, Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Alexander M Wood
- Bristol Royal Infirmary, Department of Orthopaedics, Bristol, United Kingdom of Great Britain and Northern Ireland
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