eMedicine Specialties > Sports Medicine > Hip

Femoral Neck Stress Fracture: Follow-up

Author: Scott D Flinn, MD, Medical Director, Directorate for Primary Care, Primary Care, Naval Medical Center San Diego
Contributor Information and Disclosures

Updated: Nov 7, 2007

Follow-up

Return to Play

Once the athlete has completed the walk/run rehabilitation program and is able to run 3 miles without pain, gradually increase the mileage (no more than 10% per wk) until the goal level is obtained. Gradual sport-specific drills and higher-intensity training should be accomplished over a few weeks.

Complications

Complications of FNSFs include recurrence of the stress fracture and avascular necrosis of the femoral head.

Prevention

Prevention of FNSFs includes gradually increasing the intensity and duration of training; halting/decreasing training upon return of symptoms; and reevaluating the patient for stress fracture recurrence, adequate calcium intake, and further treatment of an eating disorder (if appropriate).

Prognosis

Compression-side fractures have an excellent prognosis. Usually, if the injury is diagnosed early and the patient does not return to training too rapidly, tension-side fractures also do well. However, up to 25% of patients may have residual hip pain, discomfort, and gait problems 5-7 years after treatment.

Displaced fractures have a guarded prognosis until after surgical fixation, and then the patients undergo evaluation for another 4-6 weeks. Even after surgical fixation, displaced FNSFs have a high prevalence of avascular necrosis, with one case series reporting a rate of 24%.6 The authors reported persistent pain and a poor outcome occurred in 19% of the 42 patients.

Miscellaneous

Medicolegal Pitfalls

  • FNSFs are difficult to diagnose; however, the patient's history and physical examination findings that are indicative of pain upon internal and/or external rotation of the hip or pain upon single-leg standing or hopping should arouse clinical suspicion of an FNSF. (Note: Single-leg hopping may complete the fracture and should be discouraged.) The patient should be restricted to crutches, non-weight bearing, or touchdown weight bearing, if it causes no pain. Perform further investigation, including radiography, bone scanning, and/or MRI. A missed FSNF that was originally diagnosed as bursitis or tendonitis — thus allowing the patient to return to sports, only to have the patient snap the femoral neck and eventually require an artificial hip — is not a good outcome. A completed displaced FNSF has about a 20% chance of having a poor outcome even with surgical fixation; thus, diagnosing these injuries before completion of the fracture is essential.
 


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

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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, Medical Director, Directorate for Primary Care, Primary Care, Naval Medical Center San Diego
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, Associate Professor, Department of Physical Medicine and Rehabilitation, New Jersey Medical School; Director of Pain Management, University of Medicine and Dentistry at New Jersey, Overlook Hospital; Director of Sports Medicine, Mountainside Hospital
Gerard A Malanga, MD is a member of the following medical societies: American Academy of Pain Medicine, 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: Nothing to disclose.

Pharmacy Editor

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

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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