Femoral Neck Stress Fracture ICD-10
Femoral Neck Stress Fracture ICD-9
- 733.95 (stress fracture of Bone)
Femoral Neck Stress Fracture Etiology / Epidemiology / Natural History
- Associated with the Female Athlete Triad.
- Most commonly seen in military recruits and long distance running
- Femoral sees 8.5 times body weight with running. Repetitive loading without osteoblastic repair leads to microfractures/stress fracture.
- 0.04% of military recruits, higher in women.
Femoral Neck Stress Fracture Anatomy
- May have increased incidence and patients with femoracetabular impingement.
Femoral Neck Stress Fracture Clinical Evaluation
- hip pain, groin pain, generally in long distance runner.
- Activity related groin pain.
- Advanced stages may be unable to bear weight due to hip, groin pain.
- Groin pain with hip ROM. May have groin tenderness.
Femoral Neck Stress Fracture Xray / Diagnositc Tests
- AP pelvis, hip series may demonstrate endosteal callous formation, a sclerotic line traversing the trabeculae, or a radiolucent fracture line.
- "Gray cortex sign” = subtle decrease in definition of the affected femoral neck cortex.
- 90% of the initial radiographs and 50% of the repeat radiographs at 4 to 6 weeks may be normal.
- Bone scan or MRI: the diagnosis of femoral neck stress fracture must be ruled out with bone scan or MRI in any patient suspected of having a femoral neck stress fracture before return to any sporting activity to decrease the risk of a displaced fracture. MRI is prefered.
- MRI stress reaction = periosteal or bone marrow edema present on Short Tau Inversion Recovery (STIR) or fat-suppressed T2 sequences (Figure 2).
- MRI stress fracture = a line of decreased signal intensity perpendicular to the cortex on T1 coronal sequences with corresponding high signal intensity on T2 and STIR sequences.
- MRI with hip joint effusion is linked to failure of conserative care and need for operative fixation.
Femoral Neck Stress Fracture Classification / Treatment
- Compression-side fracture line <50% or tension side stress reaction: crutches and non-weight bearing for 6 weeks. At 6 weeks increased WB 25% per week until painless full weight bearing is achieved. When painfree may begin gradual return to activity over 4 month period. If continued pain at 6 weeks consider repeat MRI.
- Compression-side fracture line >50% or with hip joint effusion: high risk of progression, consider operative fixation with inverted triangle three cannulated screws.
- Tension-side fracture-on the superior side of the femoral neck. High risk of displacement even if non-weight bearing=ORIF. If fx displaces prognosis for return to sport is poor even after fixation
- Metabolic workup with CBC, chemistry panel, vitamin D levels.
Femoral Neck Stress Fracture Associated Injuries / Differential Diagnosis
- Acetabular Labral Tear 719.95
- Adult Hip Dysplasia
- Femoroacetabular Impingement M25.859 719.95
- Hip osteoarthritis
- Hip Arthritis M16.10 715.15
- Hip Joint Loose Body
- Iliopsoas Tendinitis M76.10 726.5
- intra-articular loose body
- Osteitis Pubis
- Pelvic Stress Fracture
- Piriformis Syndrome G57.00 355.0
- sacroiliac arthritis
- Snapping Hip Syndrome
- Spinal Pathology
- Greater Trochanteric Bursitis M70.60 726.5
- Femoral Neck Stress Fracture / reaction
- Transient Osteoporosis of the Hip
Femoral Neck Stress Fracture Complications
- Displaced femorl neck fracture
Femoral Neck Stress Fracture Follow-up Care
- Progressive weight bearing post-operatively as tolerated for 12 weeks.
- May begin return to run program at 12 weeks provided they are pain free.
Femoral Neck Stress Fracture Review References
- Bernstein EM, J Am Acad Orthop Surg 2022;30:302-311
- Boden BP, JAAOS 8:344;2000
- Mora SaA OKU-Sports Medicine 3, 139-153