Stress fractures of the femoral neck are most commonly seen in athletes, such as runners. Females are more common than males to experience stress fractures of the femoral neck. Beware of female runners with pain in the groin and normal x-rays.
The clinical findings for stress fractures of the femoral neck include groin pain, pain with weight bearing activity and negative x-ray in about 2/3 of the patients. An MRI is the best study when diagnosing stress fractures of the femoral neck. Exclude other causes of hip pain such as transient osteoporosis and avascular necrosis.
Types of Stress Fractures
Compression fractures are a callus at the inferior aspect of the femoral neck. If the fracture involves less than 50% of the femoral neck, it can be treated with non-weight-bearing and crutches, as well as restricted activity. If the fracture involves more than 50% of the femoral neck, it should be treated with screw fixation.
A tension fracture is a fracture at the superior aspect of the femoral neck. The adult bone is weak in tension and with tension the fracture will propagate. Treatment should be done with screw fixation.
A displaced fracture will have a bad prognosis especially with younger patients. There is risk of avascular necrosis and nonunion with displaced fractures. This is considered to be an emergency in younger patients. Perform a reduction and screw fixation for treatment of these fractures. It is necessary to obtain an MRI to rule out a stress fracture in elderly patients with groin pain and a normal x-ray. Use a prosthesis in the elderly.