eMedicine Specialties > Sports Medicine > Hip

Femoral Neck Stress Fracture: Differential Diagnoses & Workup

Author: Scott D Flinn, MD, Force Surgeon, Commander Naval Surface Forces
Contributor Information and Disclosures

Updated: Feb 28, 2010

Differential Diagnoses

Femoral Head Avascular Necrosis
Iliopsoas Tendinitis
Femoral Neck Fracture
Osteitis Pubis
Groin Injury
Piriformis Syndrome
Hip Dislocation
Sacroiliac Joint Injury
Hip Fracture
Slipped Capital Femoral Epiphysis
Hip Pointer
Snapping Hip Syndrome
Hip Tendonitis and Bursitis

Other Problems to Be Considered

Avascular Necrosis, Femoral Head
Bone tumors

Degenerative arthritis

Hip capsulitis and synovitis

Inflammatory arthropathy

Legg-Calve-Perthes Disease (in the Radiology section) (See also Legg-Calve-Perthes Disease [in the Emergency Medicine section] and Legg-Calve-Perthes Disease [in the Orthopedic Surgery section].)

Rectus femoris tendonitis

Referred pain from a herniated disk in the lower back

Septic hip

Slipped Capital Femoral Epiphysis (in children)

Trochanteric Bursitis

Workup

Laboratory Studies

  • Consider laboratory studies with a complete blood cell (CBC) count and erythrocyte sedimentation rate (ESR) if infection, inflammatory arthropathy, or a tumor is suspected.

Imaging Studies

  • X-ray films
    • Obtain anteroposterior and frog-leg views.
    • Obtain appropriate radiographs if femoral shaft or pubic ramus fractures are suspected. (See also the eMedicine article Femur Injuries and Fractures.)
    • If the initial radiographs are negative (and they often are), and the suspicion for FNSF is high based on the patient history and physical examination, obtain a bone scan or MRI.4 Instruct the patient to remain non-weight bearing on crutches until the study is obtained.
    • If the patient's symptoms are mild, or bone scanning or MRI is unavailable, the patient should be on crutches, non-weight bearing or touchdown weight bearing, until the bone scan/MRI is obtained or repeat films in 2 weeks are negative.
  • MRI yields more diagnostic information than bone scanning and is especially more useful in difficult cases.4

Other Tests

  • Other tests, such as hip joint aspiration for a septic joint, are only indicated if the clinician is considering alternative diagnoses.

More on Femoral Neck Stress Fracture

Overview: Femoral Neck Stress Fracture
Differential Diagnoses & Workup: Femoral Neck Stress Fracture
Treatment & Medication: Femoral Neck Stress Fracture
Follow-up: Femoral Neck Stress Fracture
Multimedia: Femoral Neck Stress Fracture
References
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References

  1. Shaffer RA, Rauh MJ, Brodine SK, Trone DW, Macera CA. Predictors of stress fracture susceptibility in young female recruits. Am J Sports Med. Jan 2006;34(1):108-15. [Medline]. [Full Text].

  2. DeFranco MJ, Recht M, Schils J, Parker RD. Stress fractures of the femur in athletes. Clin Sports Med. Jan 2006;25(1):89-103, ix. [Medline].

  3. Armstrong DW 3rd, Rue JP, Wilckens JH, Frassica FJ. Stress fracture injury in young military men and women. Bone. Sep 2004;35(3):806-16. [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. Weistroffer JK, Muldoon MP, Duncan DD, Fletcher EH, Padgett DE. Femoral neck stress fractures: outcome analysis at minimum five-year follow-up. J Orthop Trauma. May 2003;17(5):334-7. [Medline].

  6. Lee CH, Huang GS, Chao KH, Jean JL, Wu SS. Surgical treatment of displaced stress fractures of the femoral neck in military recruits: a report of 42 cases. Arch Orthop Trauma Surg. Dec 2003;123(10):527-33. [Medline].

  7. [Best Evidence] Pihlajamäki HK, Ruohola JP, Kiuru MJ, Visuri TI. Displaced femoral neck fatigue fractures in military recruits. J Bone Joint Surg Am. Sep 2006;88(9):1989-97. [Medline].

  8. Egol KA, Koval KJ, Kummer F, Frankel VH. Stress fractures of the femoral neck. Clin Orthop Relat Res. Mar 1998;348:72-8. [Medline].

  9. Jones BH, Harris JM, Vinh TN, Rubin C. Exercise-induced stress fractures and stress reactions of bone: epidemiology, etiology, and classification. Exerc Sport Sci Rev. 1989;17(1):379-422. [Medline].

  10. Carpintero P, Leon F, Zafra M, et al. Stress fractures of the femoral neck and coxa vara. Arch Orthop Trauma Surg. Jul 2003;123(6):273-7. [Medline].

  11. Stovitz SD, Arendt EA. NSAIDs should not be used in treatment of stress fractures [letter]. Am Fam Physician. Oct 15 2004;70(8):1452, 1454. [Medline]. [Full Text].

  12. Beck TJ, Ruff CB, Mourtada FA, et al. Dual-energy X-ray absorptiometry derived structural geometry for stress fracture prediction in male U.S. Marine Corps recruits. J Bone Miner Res. May 1996;11(5):645-53. [Medline].

  13. Blomfeldt R, Törnkvist H, Eriksson K, et al. A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br. Feb 2007;89(2):160-5. [Medline].

  14. Kunesová M, Koudela K Jr, Koudela K Sr, Koudelová J. [Magnetic resonance imaging for examination of proximal femoral fractures: its contribution to clinical medicine] [Czech]. Acta Chir Orthop Traumatol Cech. Dec 2006;73(6):380-6. [Medline].

  15. Lloyd T, Petit MA, Lin HM, Beck TJ. Lifestyle factors and the development of bone mass and bone strength in young women. J Pediatr. Jun 2004;144(6):776-82. [Medline].

  16. Macaulay W, Yoon RS, Parsley B, Nellans KW, Teeny SM. Displaced femoral neck fractures: is there a standard of care?. Orthopedics. Sep 2007;30(9):748-9. [Medline].

  17. Maitra RS, Johnson DL. Stress fractures. Clinical history and physical examination. Clin Sports Med. Apr 1997;16(2):259-74. [Medline].

  18. Pihlajamäki HK, Ruohola JP, Weckström M, Kiuru MJ, Visuri TI. Long-term outcome of undisplaced fatigue fractures of the femoral neck in young male adults. J Bone Joint Surg Br. Dec 2006;88(12):1574-9. [Medline].

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

  20. Raaymakers EL. Fractures of the femoral neck: a review and personal statement. Acta Chir Orthop Traumatol Cech. 2006;73(1):45-59. [Medline].

  21. Shimizu T, Miyamoto K, Masuda K, et al. The clinical significance of impaction at the femoral neck fracture site in the elderly. Arch Orthop Trauma Surg. Sep 2007;127(7):515-21. [Medline].

  22. Strömqvist B, Hansson LI, Ljung P, Ohlin P, Roos H. Pre-operative and postoperative scintimetry after femoral neck fracture. J Bone Joint Surg Br. Jan 1984;66(1):49-54. [Medline]. [Full Text].

  23. Yih-Shiunn L, Chien-Rae H, Wen-Yun L. Surgical treatment of undisplaced femoral neck fractures in the elderly. Int Orthop. Oct 2007;31(5):677-82. [Medline].

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Further Reading

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Keywords

stress fracture of the hip, hip pain, hip replacement, total hip replacement, femoral stress fracture, FNSFs

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Contributor Information and Disclosures

Author

Scott D Flinn, MD, Force Surgeon, Commander Naval Surface Forces
Scott D Flinn, MD is a member of the following medical societies: American Academy of Family Physicians and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Medical Editor

Gerard A Malanga, MD, Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine
Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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