Return to Play

Return-to-play criteria in patients following femoral neck fractures require the athlete to have an absence of signs or symptoms of the original injury, full range of motion, normal strength and flexibility, and normal sport-specific mechanics. Athletes must be aware of their own limitations, which is particularly important for the individual gradually returning to a competitive level of activity after injury.^[26]

Prevention

Patient education is an important factor in the prevention of stress fractures. Female athletes should decrease their risk of recurrent fractures by maintaining adequate muscle mass and bone density.

Maintaining proper flexibility is also thought to play a significant role in the prevention of sports-related injuries. Additionally, improvement in aerobic fitness can increase blood flow and oxygenation to all tissues, including the muscles and bones, and it would be a reasonable addition to any rehabilitation and prevention program. Seasonal athletes should be encouraged to cross-train all year or at least undergo preconditioning before participating in their particular sport.

Schnackenburg KE, Macdonald HM, Ferber R, Wiley JP, Boyd SK. Bone quality and muscle strength in female athletes with lower limb stress fractures. Med Sci Sports Exerc. 2011 Nov. 43(11):2110-9. [QxMD MEDLINE Link].
Singh PJ, O'Donnell JM. The outcome of hip arthroscopy in Australian football league players: a review of 27 hips. Arthroscopy. 2010 Jun. 26(6):743-9. [QxMD MEDLINE Link].
Konetsky M, Miller J, Tripp C. Femoral neck stress fracture. J Orthop Sports Phys Ther. 2013 Apr. 43(4):275. [QxMD MEDLINE Link].
Monteleone GP Jr. Stress fractures in the athlete. Orthop Clin North Am. 1995 Jul. 26(3):423-32. [QxMD MEDLINE Link].
Markey KL. Stress fractures. Clin Sports Med. 1987 Apr. 6(2):405-25. [QxMD MEDLINE Link].
Plancher KD, Donshik JD. Femoral neck and ipsilateral neck and shaft fractures in the young adult. Orthop Clin North Am. 1997 Jul. 28(3):447-59. [QxMD MEDLINE Link].
Brukner P. Sports medicine. The tired athlete. Aust Fam Physician. 1996 Aug. 25(8):1283-8. [QxMD MEDLINE Link].
Lakstein D, Hendel D, Haimovich Y, Feldbrin Z. Changes in the pattern of fractures of the hip in patients 60 years of age and older between 2001 and 2010: A radiological review. Bone Joint J. 2013 Sep. 95-B(9):1250-4. [QxMD MEDLINE Link].
Koval KJ, Zuckerman JD. Hip fractures: I. Overview and evaluation and treatment of femoral-neck fractures. J Am Acad Orthop Surg. 1994 May. 2(3):141-149. [QxMD MEDLINE Link].
Joshi N, Pidemunt G, Carrera L, Navarro-Quilis A. Stress fracture of the femoral neck as a complication of total knee arthroplasty. J Arthroplasty. 2005 Apr. 20(3):392-5. [QxMD MEDLINE Link].
Volpin G, Hoerer D, Groisman G, Zaltzman S, Stein H. Stress fractures of the femoral neck following strenuous activity. J Orthop Trauma. 1990. 4(4):394-8. [QxMD MEDLINE Link].
Zahger D, Abramovitz A, Zelikovsky L, Israel O, Israel P. Stress fractures in female soldiers: an epidemiological investigation of an outbreak. Mil Med. 1988 Sep. 153(9):448-50. [QxMD MEDLINE Link].
Maitra RS, Johnson DL. Stress fractures. Clinical history and physical examination. Clin Sports Med. 1997 Apr. 16(2):259-74. [QxMD MEDLINE Link].
Devas MB. Stress fractures of the femoral neck. J Bone Joint Surg Br. 1965 Nov. 47(4):728-38. [QxMD MEDLINE Link]. [Full Text].
Fullerton LR Jr, Snowdy HA. Femoral neck stress fractures. Am J Sports Med. 1988 Jul-Aug. 16(4):365-77. [QxMD MEDLINE Link].
Shin AY, Morin WD, Gorman JD, Jones SB, Lapinsky AS. The superiority of magnetic resonance imaging in differentiating the cause of hip pain in endurance athletes. Am J Sports Med. 1996 Mar-Apr. 24(2):168-76. [QxMD MEDLINE Link].
Holder LE, Schwarz C, Wernicke PG, Michael RH. Radionuclide bone imaging in the early detection of fractures of the proximal femur (hip): multifactorial analysis. Radiology. 1990 Feb. 174(2):509-15. [QxMD MEDLINE Link]. [Full Text].
Quinn SF, McCarthy JL. Prospective evaluation of patients with suspected hip fracture and indeterminate radiographs: use of T1-weighted MR images. Radiology. 1993 May. 187(2):469-71. [QxMD MEDLINE Link]. [Full Text].
Dai ZZ, Zhang ZQ, Ding J, et al. Analysis of risk factors for complications after femoral neck fracture in pediatric patients. J Orthop Surg Res. 2020 Feb 19. 15 (1):58. [QxMD MEDLINE Link].
Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J. Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment. J Bone Joint Surg Br. 2005 Apr. 87(4):523-9. [QxMD MEDLINE Link].
Stappaerts KH. Early fixation failure in displaced femoral neck fractures. Arch Orthop Trauma Surg. 1985. 104(5):314-8. [QxMD MEDLINE Link].
Scheck M. The significance of posterior comminution in femoral neck fractures. Clin Orthop Relat Res. 1980 Oct. 152:138-42. [QxMD MEDLINE Link].
Heetveld MJ, Raaymakers EL, van Eck-Smit BL, van Walsum AD, Luitse JS. Internal fixation for displaced fractures of the femoral neck. Does bone density affect clinical outcome?. J Bone Joint Surg Br. 2005 Mar. 87(3):367-73. [QxMD MEDLINE Link].
Moroni A, Hoque M, Waddell JP, Russell TA, Wippermann B, Digiovanni G. Surgical treatment and management of hip fracture patients. Arch Orthop Trauma Surg. 2011 Dec 6. [QxMD MEDLINE Link].
Wang F, Zhang H, Zhang Z, Ma C, Feng X. Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord. 2015 Aug 28. 16:229. [QxMD MEDLINE Link].
Nattiv A, Kennedy G, Barrack MT, Abdelkerim A, Goolsby MA, Arends JC, et al. Correlation of MRI grading of bone stress injuries with clinical risk factors and return to play: a 5-year prospective study in collegiate track and field athletes. Am J Sports Med. 2013 Aug. 41(8):1930-41. [QxMD MEDLINE Link].
Arnold WD. The effect of early weight-bearing on the stability of femoral neck fractures treated with Knowles pins. J Bone Joint Surg Am. 1984 Jul. 66(6):847-52. [QxMD MEDLINE Link]. [Full Text].
Barnes R, Brown JT, Garden RS, Nicoll EA. Subcapital fractures of the femur. A prospective review. J Bone Joint Surg Br. 1976 Feb. 58(1):2-24. [QxMD MEDLINE Link]. [Full Text].
Blickenstaff LD, Morris JM. Fatigue fracture of the femoral neck. J Bone Joint Surg Am. 1966 Sep. 48(6):1031-47. [QxMD MEDLINE Link]. [Full Text].
Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. J Bone Joint Surg Am. 2005 Aug. 87(8):1680-8. [QxMD MEDLINE Link].
Egol KA, Dolan R, Koval KJ. Functional outcome of surgery for fractures of the ankle. A prospective, randomised comparison of management in a cast or a functional brace. J Bone Joint Surg Br. 2000 Mar. 82(2):246-9. [QxMD MEDLINE Link]. [Full Text].
Fairclough J, Colhoun E, Johnston D, Williams LA. Bone scanning for suspected hip fractures. A prospective study in elderly patients. J Bone Joint Surg Br. 1987 Mar. 69(2):251-3. [QxMD MEDLINE Link]. [Full Text].
Figved W, Opland V, Frihagen F, et al. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop Relat Res. 2009 Jan 7. epub ahead of print. [QxMD MEDLINE Link].
Garden RS. The significance of good reduction in medial fractures of the femoral neck. Proc R Soc Med. 1970 Nov. 63(11 pt 1):1122. [QxMD MEDLINE Link]. [Full Text].
Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am. 2004 Aug. 86-A(8):1711-6. [QxMD MEDLINE Link].
Karanicolas PJ, Bhandari M, Walter SD, Heels-Ansdell D, Guyatt GH. Radiographs of hip fractures were digitally altered to mask surgeons to the type of implant without compromising the reliability of quality ratings or making the rating process more difficult. J Clin Epidemiol. 2009 Feb. 62(2):214-223.e1. [QxMD MEDLINE Link].
Magu NK, Rohilla R, Singh R, Tater R. Modified Pauwels' intertrochanteric osteotomy in neglected femoral neck fracture. Clin Orthop Relat Res. 2009 Jan 14. epub ahead of print. [QxMD MEDLINE Link].

Media Gallery

Posterior view of the extraosseous blood supply to the femoral head.
Anterior view of the extraosseous blood supply to the femoral head.
Garden fracture classification.
Classification of femoral neck stress fractures.

of 4

Author

Gerard A Malanga, MD † Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; 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, American Institute of Ultrasound in Medicine, International Spine Intervention Society, North American Spine Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Lipogems.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

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 Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Neil N Jasey, Jr, MD Staff Physician, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey

Disclosure: Nothing to disclose.

Jennifer Solomon, MD Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey

Jennifer Solomon, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, and Medical Society of the State of New York

Disclosure: Nothing to disclose.