Femoral Neck Stress Fracture Follow-up

Updated: May 31, 2017
  • Author: Scott D Flinn, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Follow-up

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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.

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Complications

Nondisplaced compression-side FNSF appears to have no increased long-term risk for avascular necrosis of the femoral head or osteoarthritis for these patients. [17]

Compression-side nondisplaced FNSFs may recur and become displaced, especially if the patient is returned to activity too quickly. Displaced tension-side FNSFs have complications that include avascular necrosis of the femoral head and need for total hip arthroplasty (THA).

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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; providing adequate calcium intake, and further treatment of an eating disorder if appropriate.

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Prognosis

FNSFs are often difficult to diagnose. The patient's history of increasing hip pain while running and physical examination findings of pain upon internal and/or external rotation of the hip or pain upon single-leg standing should arouse clinical suspicion of an FNSF. (Note: Single-leg hopping on the affected leg may complete the fracture and should be highly 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, with the patient allowed to return to sports, only to have the patient snap the femoral neck and eventually require an artificial hip, is obviously not the desired outcome. A completed displaced FNSF has about a 25% chance of having a poor outcome even with surgical fixation; thus, diagnosing these injuries before completion of the fracture is essential.

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