A femoral neck stress fracture is defined as the most common stress fracture of the femur and is a type of injury that stems from fatigue and insufficiency of the skeletal structure to maintain its function and integrity [1] [2]. Hence, it is not surprising that athletes (particularly endurance runners and other sports that put a significant weight on the hip joint for a prolonged period of time) and especially military personnel are the primary groups in whom a femoral neck stress fracture is encountered [1] [3] [4]. Elderly individuals suffering from a degenerative bone disease (mainly osteoporosis) are the second important class of patients who are at increased risk [1] [5]. A strong predilection towards female gender exists when it comes to femoral neck stress fracture and stress fractures in general [1] [2] [3]. In fact, the "female athlete triad" - amenorrhea, eating disorders, and osteopenia greatly predisposes to a stress fracture [1] [4]. The most important sign is anterior groin pain [5] [6]. Pain is usually absent at rest and appears during physical activity (for example, during running), one of the key findings that point toward this clinical entity [5] [6]. Additional features include erythema, local swelling, reduced range of motion at the hip joint, and pain when rotating the hip [1] [5].

• Disability

  Abstract Stress fractures are a common overuse problem among military trainees resulting in preventable morbidity, prolonged training, and long-term disability following military service. [ncbi.nlm.nih.gov]

  Please enable JS and disable any ad blocker [rheumatologynetwork.com]

  Unfortunately, certain musculoskeletal injuries are difficult to recognize for a variety of reasons and, when not diagnosed early, may develop into chronic disabling conditions. [aafp.org]

  Stress fractures are an uncommon cause of hip pain which can be easily missed and lead to very disabling complications owing to the displacement of the fracture. [latunisiemedicale.com]

• Localized Pain

  Clinical Relevance Unexplained lower extremity localized pain in athletic or military personnel should be potentially considered a stress fracture with the resultant work-up necessary to diagnose this disorder. [neckandback.com]

  These cracks lead to swelling in the bone marrow, muscular tightness in the surrounding area, and of course, a sharp localized pain on the bone. [runnersconnect.net]

  Signs and symptoms of a femoral stress fracture Patients with this condition typically experience a poorly localized pain in the front of the thigh that increases with impact activity (such as running, jumping, sprinting and hopping) and decreases with [physioadvisor.com.au]

  I woke up today (thurs) and had a stitch in the middle of my leg, no localized pain to the touch as I have had in the past. The pain/stitch seems like it is on my tibia wedged between my calve seems like it may be similar to what TK5 is describing. [coolrunning.com]

  pain and tenderness over the fibula, with occasional referred knee pain. 3, 9, 15, 29, 47 Signs and symptoms specific to fibular stress fractures are typical with a history of progressive pain during activity, focal tenderness, and localized swelling [dovepress.com]

• Military Personnel

  Hence, it is not surprising that athletes (particularly endurance runners and other sports that put a significant weight on the hip joint for a prolonged period of time) and especially military personnel are the primary groups in whom a femoral neck stress [symptoma.com]

  Clinical Relevance Unexplained lower extremity localized pain in athletic or military personnel should be potentially considered a stress fracture with the resultant work-up necessary to diagnose this disorder. [neckandback.com]

  One of the highest proportions of stress fracture incidence rates in women is found in military personnel. [2] Another common group of women who have the tendency to develop stress fractures are endurance athletes who perform repetitive weight-bearing [sjosm.org]

• Anemia

  Epub 2009 Feb 14. 〔 PUBMED 〕 The relationship between anemia at admission and outcome in patients older than 60 years with hip fracture. J Orthop Traumatol. 2009 Sep;10(3):119-22. [kofu.hosp.go.jp]

• Hip Pain

  Because the condition may lead to disastrous complications, femoral neck stress fracture must also be kept in mind in the differential diagnosis of pediatric hip pain. [ncbi.nlm.nih.gov]

• Coxa Vara

  Stress fractures of the femoral neck and coxa vara. Arch Orthop Trauma Surg 2003 ;123 :273-7. [latunisiemedicale.com]

  Stress fractures of the femoral neck and coxa vara. Arch Orthop Trauma Surg. 2003 Jul. 123(6):273-7. [Medline]. Beck TJ, Ruff CB, Mourtada FA, et al. [emedicine.medscape.com]

• Knee Pain

  Symptoms persisted and the patient underwent an MRI of the knee, which revealed a mild degenerative meniscal tear that was then assumed to be a cause of femoral pain radiating to the knee. [78stepshealth.us]

  Slipped capital femoral epiphysis should be suspected in the child with a history of hip, groin, thigh or knee pain who walks with a limp. [aafp.org]

  […] and tenderness over the fibula, with occasional referred knee pain. 3, 9, 15, 29, 47 Signs and symptoms specific to fibular stress fractures are typical with a history of progressive pain during activity, focal tenderness, and localized swelling. 29 [dovepress.com]

  Epub 2014 Mar 12.〔 PUBMED 〕 Usefulness of knee arthroscopy for diagnosis of knee pain in pediatric patients: comparison with preoperative clinical diagnosis. Arch Orthop Trauma Surg. 2013 May; 133(5): 669-73. [kofu.hosp.go.jp]

• Sciatica

  リハビリテーション replacement置換［術］ resection切除［術］ rheumatoid arthritis (RA) 関節リウマチ rib肋骨 ricketsくる病 root［神経］根 rotation１．回旋、軸旋、２．捻転 rotator cuff［肩］［回旋筋］腱板 s sacral 仙骨の、仙椎の sacrum 仙骨 salvage operationサルベージ手術、救済手術 sarcoidosisサルコイドーシス sarcoma肉腫 sciatic nerve坐骨神経 sciatica [tokyo-med.ac.jp]

  – 17, 19 Symptoms include low back and/or buttock pain typically exacerbated by single leg hopping. 1 – 21 Sacral stress fractures are difficult to diagnose given the symptoms are representative of several injuries including low back, disk disease, sciatica [dovepress.com]

• Amenorrhea

  Keywords Osteoporosis Stress Fracture Eating Disorder Amenorrhea Female Athlete These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. [springerlink.com]

  In fact, the "female athlete triad" - amenorrhea, eating disorders, and osteopenia greatly predisposes to a stress fracture. The most important sign is anterior groin pain. [symptoma.com]

  […] frx of femoral neck are relatively uncommon injuries, with most reports involving military recruits & athletes who are subjected to increased physical demands; - like most stress frx, women are most often affected and it is important to inquire about amenorrhea [wheelessonline.com]

  Pathophysiology repetitive loading causes microscopic fractures in the femoral neck crack "initiation" continued repetitive loading does not allow for healing response and stress fracture occurs crack "propagation" Associated conditions " female athlete triad " amenorrhea [orthobullets.com]

  Hip stress fractures often occuer in long distance female runners who have amenorrhea or anorexia. Stress fractures often develop because of training errors. [iskinstitute.com]

Although signs and symptoms of a femoral neck stress fracture are evident in most cases, studies have confirmed that a significant amount of time (several weeks to even months) passes from initial injury to the diagnosis [1] [2] [5] [6] [7]. This delay in recognition puts the patient at risk for the development of numerous complications, one of them being displacement of the hip [1] [5]. Hence, the physician must obtain a detailed history (during which the exact course of symptoms and injury occurrence must be covered) and perform a physical examination that will reveal the location of the injury (although this may not be enough in the case of minor injuries) [1] [6]. The hop test (hopping on the affected extremity) is established as a reliable non-specific exam for bony injury of the hip and about 70% of individuals with a femoral neck stress fracture report pain during this examination [1]. To make a definite diagnosis, imaging studies need to be employed. Plain radiography is a useful first-line study that can detect stress fractures [1] [5], but many patients have normal radiographs, which is why more advanced studies are necessary when clinical and X-ray findings are not in accordance. Computed tomography (CT) is not recommended for evaluation of skeletal injuries, but magnetic resonance imaging (MRI) and bone scintigraphy are regarded as the crucial methods to delineate the exact site of fracture and its severity [1] [5] [6].

For adequate treatment, early diagnosis by MRT or bone scintigraphy is essential. Conservative treatment will be effective through prevention of overuse. [ncbi.nlm.nih.gov]

Our treatment algorithm addresses the unique differences associated with this injury in immature patients and allows for early diagnosis and treatment to prevent complications. © Lippincott-Raven Publishers. Related Articles [journals.lww.com]

Also read: Stress fractures: Frequently asked questions Treatment of a femoral neck stress fracture Treatment of the femoral neck stress fracture depends on where the injury occurs. [drdavidgeier.com]

Compression-side fractures should be referred as appropriate for expert care if not familiar with their treatment. Follow the acute treatment principles of protection, rest, ice, compression, elevation, medication, and modalities (PRICEMM). [emedicine.medscape.com]

If fx displaces prognosis for return to sport is poor even after fixation Femoral Neck Stress Fracture Associated Injuries / Differential Diagnosis Acetabular Labral Tear 719.95 Adult Hip Dysplasia Femoroacetabular Impingement M25.859 719.95 hernia Hip [eorif.com]

[…] repetitive loading does not allow for healing response and stress fracture occurs crack "propagation" Associated conditions " female athlete triad " amenorrhea, eating disorder, and osteoporosis must be considered in any female athlete with stress fracture Prognosis [orthobullets.com]

J Bone Joint Surg Br. 88(8): 1093-5, 2006.〔 JBJS 〕〔 PUBMED 〕 Prediction of ambulation prognosis in the elderly after hip fracture. Int Orthop. 30(5): 315-9, 2006.〔 PUBMED 〕 Prognosis of proximal femoral fracture in patients aged 90 years and older. [kofu.hosp.go.jp]

Displacement of the femoral neck stress fracture is the main determinant of outcome, significantly worsening the prognosis for the patient. [bjsm.bmj.com]

The displacement of femoral neck fractures is the main determinant of prognosis. Displaced fractures result in a 60% reduction in patient activity level in sports. There is an associated 30% risk of avascular necrosis of the femoral head [75]. [78stepshealth.us]

However, due to the potential for morbidity and high medical costs often associated with a femoral neck stress fracture, clinicians must be familiar with the etiology of the disorder and ways to modify certain parameters that may influence its development [bartoldgold.com]

[…] synonyms: Femoral Neck Stress Fracture ICD-10 M84.359A Stress fracture, hip, unspecified, initial fracture Femoral Neck Stress Fracture ICD-9 733.95 (stress fracture of Bone) Femoral Neck Stress Fracture Etiology / Epidemiology / Natural History Associated [eorif.com]

Studiu descriptiv, de evaluare a spectrului etiologic al SPI 2. Studiu diagnostic de evaluare a acuratetei TNF-alfa, IL- 1 beta, More information [healthdocbox.com]

Exercise-induced stress fractures and stress reactions of bone: epidemiology, etiology, and classification. Exerc Sport Sci Rev. 1989. 17(1):379-422. [Medline]. Carpintero P, Leon F, Zafra M, et al. [emedicine.medscape.com]

We perform a literature review of studies showing epidemiology, treatment algorithms and rehabilitation. 2016 BMJ Publishing Group Ltd. [ncbi.nlm.nih.gov]

COSTACHE¹ Abstract: We have conducted a retrospective study More information Femoral Neck Fractures Femoral Neck Fractures Michael Monge, Harvard Medical School Agenda Epidemiology Normal anatomy of the femur Garden classifications Patients Summary 1 [healthdocbox.com]

[…] synonyms: Femoral Neck Stress Fracture ICD-10 M84.359A Stress fracture, hip, unspecified, initial fracture Femoral Neck Stress Fracture ICD-9 733.95 (stress fracture of Bone) Femoral Neck Stress Fracture Etiology / Epidemiology / Natural History Associated [eorif.com]

Introduction Fracture of the femoral neck secondary to repetitive loading of bone two types compression side (inferior-medial neck) tension side (superior-lateral neck) Epidemiology common in runners Mechanism repetitive loading of femoral neck Pathophysiology [orthobullets.com]

Exercise-induced stress fractures and stress reactions of bone: epidemiology, etiology, and classification. Exerc Sport Sci Rev. 1989. 17(1):379-422. [Medline]. Carpintero P, Leon F, Zafra M, et al. [emedicine.medscape.com]

The pathophysiology and practical management issues related to this unusual injury pattern are discussed. [ncbi.nlm.nih.gov]

Introduction Fracture of the femoral neck secondary to repetitive loading of bone two types compression side (inferior-medial neck) tension side (superior-lateral neck) Epidemiology common in runners Mechanism repetitive loading of femoral neck Pathophysiology [orthobullets.com]

Appropriate physiatric history and physical examination, along with indicated studies, will help prevent misdiagnosis and potentially serious complications associated with musculoskeletal pathology. [ncbi.nlm.nih.gov]

Department of Family and Preventive Medicine University of Utah Salt Lake City USA [springerlink.com]

1. Avrahami D, Pajaczkowski JA. Femoral neck stress fracture in a female athlete: a case report. J Chiropr Med. 2012;11(4):273-279.
2. Niva MH, Kiuru MJ, Haataja R, Pihlajamaki HK. Fatigue injuries of the femur. J Bone Joint Surg Br. 2005;87:1385–1390
3. Niva M.H., Mattila VM, Kiuru MJ, Pihlajamaki HK. Bone stress injuries are common in female military trainees: a preliminary study. Clin Orthop Relat Res. 2009;467:2962–2969.
4. Okamoto S, Arai Y, Hara K, Tsuzihara T, Kubo T. A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: a case report. Sports Med Arthrosc Rehabil Ther Technol. 2010;2:6.
5. Onibere OA, Sugathan HK. A case report of missed femoral neck stress fracture. SICOT-J. 2015;1:2.
6. O’Kane JW. Anterior hip pain. Am Fam Physician. 1999;60(6):1687–1696.
7. Clough TM. Femoral neck stress fracture: the importance of clinical suspicion and early review. Br J Sports Med. 2002;36(4):308–309.