eMedicine Specialties > Orthopedic Surgery > Hip

Femoral Neck Stress and Insufficiency Fractures: Follow-up

Author: Michael S Wildstein, MD, Associate Professor of Orthopaedic Surgery, Charleston Veterans Affairs Medical Center; Attending Physician, Wildstein Spine Center, PA
Coauthor(s): H Del Schutte, Jr, MD, Associate Professor of Orthopedic Surgery, Department of Orthopedic Surgery, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Mar 4, 2009

Outcome and Prognosis

The prognosis for femoral neck stress fractures depends largely on the classification of the fracture.22 Compression-type injuries historically fare very well, with the patient recovering full preinjury function after diligent adherence to a physician-prescribed plan of limited weightbearing and walking with an aid. Transverse-type fractures, when identified early and with the only radiographic abnormality being sclerotic changes, tend to recover well after internal fixation. Potential lasting effects of surgical management include hip pain and nonunion or malunion of the fracture. The worst prognosis exists for transverse fractures that are inherently unstable because of mechanical reasons and that can progress to complete displaced fractures.23 The rate of nonunion and AVN in these cases is as high as 35%, according to some authors.

Future and Controversies

Debate currently exists over the surgical treatment of transverse-type femoral neck stress fractures in older patients. Given that most individuals who sustain true stress fractures (as distinguished from insufficiency fractures) are young and healthy, only a small number of individuals are affected by this controversy.

The 2 current methods of fixation include internal fixation and prosthetic replacement. Multiple studies comparing the 2 modalities of fracture fixation for these types of injuries have demonstrated widely varying results. Infection rates, morbidity, mortality, and patient satisfaction have been examined without a definitive answer gleaned. Additionally, the prosthetic opponents point out that the cost and potential complications of the components are not justifiable for individuals whose remaining life expectancy might be half that of the implant.

As the population ages and more individuals live longer, healthier lives, this debate is certain to continue. In addition, although the principles of fixation will likely remain the same, how they are applied to an individual today will probably differ from how they are applied a decade from now.

Materials are certain to continue to advance, and with an increasingly active population, the demands placed on the human body and on prosthetics remain to be seen. Only time and experience will bear answers to these questions.

 


More on Femoral Neck Stress and Insufficiency Fractures

Overview: Femoral Neck Stress and Insufficiency Fractures
Workup: Femoral Neck Stress and Insufficiency Fractures
Treatment: Femoral Neck Stress and Insufficiency Fractures
Follow-up: Femoral Neck Stress and Insufficiency Fractures
Multimedia: Femoral Neck Stress and Insufficiency Fractures
References
Further Reading
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References

  1. Ernst J. Stress Fracture of the Neck of the Femur. J Trauma. Jan 1964;53:71-83. [Medline].

  2. The classic: treatment of fractures of the neck of the femur by internal fixation. Clin Orthop Relat Res. Sep-Oct 1967;54:3-11. [Medline].

  3. De Paulis F, Cacchio A, Michelini O, et al. Sports injuries in the pelvis and hip: diagnostic imaging. Eur J Radiol. May 1998;27(Suppl 1):S49-59. [Medline].

  4. Shin AY, Gillingham BL. Fatigue fractures of the femoral neck in athletes. J Am Acad Orthop Surg. Nov 1997;5(6):293-302. [Medline].

  5. Waters PM, Millis MB. Hip and pelvic injuries in the young athlete. Clin Sports Med. Jul 1988;7(3):513-26. [Medline].

  6. Zeni AI, Street CC, Dempsey RL, et al. Stress injury to the bone among women athletes. Phys Med Rehabil Clin N Am. Nov 2000;11(4):929-47. [Medline].

  7. Johansson C, Ekenman I, Tornkvist H, et al. Stress fractures of the femoral neck in athletes. The consequence of a delay in diagnosis. Am J Sports Med. Sep-Oct 1990;18(5):524-8. [Medline].

  8. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am. Oct 2008;90(10):2254-66. [Medline].

  9. Stoneham MD, Morgan NV. Stress fractures of the hip in Royal Marine recruits under training: a retrospective analysis. Br J Sports Med. Sep 1991;25(3):145-8. [Medline].

  10. Volpin G, Hoerer D, Groisman G, et al. Stress fractures of the femoral neck following strenuous activity. J Orthop Trauma. 1990;4(4):394-8. [Medline].

  11. Blickenstaff LD, Morris JM. Fatigue fracture of the femoral neck. J Bone Joint Surg Am. Sep 1966;48(6):1031-47. [Medline].

  12. Lehman RA, Shah SA. Tension-sided femoral neck stress fracture in a skeletally immature patient. A case report. J Bone Joint Surg Am. Jun 2004;86-A(6):1292-5. [Medline].

  13. Niva MH, Kiuru MJ, Haataja R, et al. Fatigue injuries of the femur. J Bone Joint Surg Br. Oct 2005;87(10):1385-90. [Medline].

  14. Muldoon MP, Padgett DE, Sweet DE, et al. Femoral neck stress fractures and metabolic bone disease. J Orthop Trauma. Mar-Apr 2001;15(3):181-5. [Medline].

  15. Devas MB. Stress fractures of the femoral neck. J Bone Joint Surg Br. Nov 1965;47(4):728-38. [Medline]. [Full Text].

  16. Qian JG, Song YW, Tang X, Zhang S. Examination of femoral-neck structure using finite element model and bone mineral density using dual-energy X-ray absorptiometry. Clin Biomech (Bristol, Avon). Nov 1 2008;[Medline].

  17. Evans PD, Wilson C, Lyons K. Comparison of MRI with bone scanning for suspected hip fracture in elderly patients. J Bone Joint Surg Br. Jan 1994;76(1):158-9. [Medline]. [Full Text].

  18. Provencher MT, Baldwin AJ, Gorman JD, et al. Atypical tensile-sided femoral neck stress fractures: the value of magnetic resonance imaging. Am J Sports Med. Sep 2004;32(6):1528-34. [Medline].

  19. Shin AY, Morin WD, Gorman JD, et al. The superiority of magnetic resonance imaging in differentiating the cause of hip pain in endurance athletes. Am J Sports Med. Mar-Apr 1996;24(2):168-76. [Medline].

  20. Bonnaire F, Götschin U, Kuner EH. [Early and late results of 200 DHS osteosyntheses in the reconstruction of pertrochanteric femoral fractures]. Unfallchirurg. May 1992;95(5):246-53. [Medline].

  21. Roetman B, Scholz N, Muhr G, Möllenhoff G. [Augmentive plate fixation in femoral non-unions after intramedullary nailing. Strategy after unsuccessful intramedullary nailing of the femur]. Z Orthop Unfall. Sep-Oct 2008;146(5):586-90. [Medline].

  22. Sanders DW, MacLeod M, Charyk-Stewart T, Lydestad J, Domonkos A, Tieszer C. Functional outcome and persistent disability after isolated fracture of the femur. Can J Surg. Oct 2008;51(5):366-70. [Medline].

  23. Gjertsen JE, Vinje T, Lie SA, Engesaeter LB, Havelin LI, Furnes O, et al. Patient satisfaction, pain, and quality of life 4 months after displaced femoral neck fractures: a comparison of 663 fractures treated with internal fixation and 906 with bipolar hemiarthroplasty reported to the Norwegian Hip Fracture Register. Acta Orthop. Oct 2008;79(5):594-601. [Medline].

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Keywords

femoral neck stress, femoral neck fracture, femoral neck stress fracture, femur injuries, hip fracture, fatigue fracture, insufficiency fracture, pseudofracture, exhaustion fracture, Deutschlãnder's fracture, Deutschlãnder fracture, Deutschlander's fracture, Deutschlander fracture, spontaneous fracture, march fracture, hip pain

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Contributor Information and Disclosures

Author

Michael S Wildstein, MD, Associate Professor of Orthopaedic Surgery, Charleston Veterans Affairs Medical Center; Attending Physician, Wildstein Spine Center, PA
Michael S Wildstein, MD is a member of the following medical societies: American Medical Association, South Carolina Medical Association, and Southern Orthopaedic Association
Disclosure: Medtronic Honoraria Speaking and teaching; Stryker spine Honoraria Speaking and teaching

Coauthor(s)

H Del Schutte, Jr, MD, Associate Professor of Orthopedic Surgery, Department of Orthopedic Surgery, Medical University of South Carolina
H Del Schutte, Jr, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, American Medical Association, American Orthopaedic Association, California Medical Association, Orthopaedic Research Society, South Carolina Medical Association, Southern Medical Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

Medical Editor

Steven I Rabin, MD, Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic
Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

B Sonny Bal, MD, Associate Professor, Department of Orthopedic Surgery, University of Missouri School of Medicine
B Sonny Bal, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

William L Jaffe, MD, Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Vice Chairman, Department of Orthopedic Surgery, New York University Hospital for Joint Diseases
William L Jaffe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, Eastern Orthopaedic Association, and New York Academy of Medicine
Disclosure: Stryker Orthopaedics Consulting fee Speaking and teaching

 
 
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