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CASE REPORT
Year : 2015  |  Volume : 15  |  Issue : 3  |  Page : 299-300

Stress fracture of the femoral neck in a military recruit


1 Department of Orthopaedics, BGS GIMS Hospital, Bengaluru, Karnataka, India
2 Sapthagiri Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India

Date of Web Publication2-Sep-2015

Correspondence Address:
Raju Kolur Puttaswamy
Department of Orthopaedics, BGS GIMS Hospital, Kengeri, Bengaluru - 560 060, Karnataka
India
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DOI: 10.4103/1319-6308.164322

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  Abstract 

The patient was a 25-year-old male who was currently enrolled in a military security forces training program. He had a 1-month history of worsening left anterior hip pain that was insidious in nature and limiting his ability to run. History and physical examination findings led to the possibility of femoral neck stress fracture. Radiography of the left hip was obtained, which revealed a stress fracture of the left femoral neck. The patient underwent open reduction internal fixation of the left hip. After a period of convalescence and completion of a comprehensive rehabilitation program, the patient successfully returned to full military duty without limitations.

  Abstract in Arabic 

كسر الإجهاد لعنق عظم الفخذ فى مجند عسكرى - تقرير الحالة.
كان عمر المريض 25 عاما وقد التحق ببرنامج تدريب قوات الأمن يالجيش مؤخرا، و قد عانى من الذى يزداد تذريجيا و أصبح يزداد سوءاً لمدة شهر مما أدى إلى الحدّ من قدرته على الرّكض و قد أظهر الكشف الطبيّ وجود كسر في عنق عظم الفخذ نتيجة لللإجهاد و بعد إجراء صورة أشعة كشفت عن كسر في عتق عظم الفخذ نتيجة وخضع المريض لعملية مفتوحة لإرجاع الكسر و ثبيته داخليا. و بعد انتهاء فترة النقاهة و إكمال يرنامج التأهيل استطاع العودة لى الخدمة الوطنية بدون أي عوائق.

Keywords: Femoral neck, military, stress fracture


How to cite this article:
Puttaswamy RK, Jagadeesan MK. Stress fracture of the femoral neck in a military recruit. Saudi J Sports Med 2015;15:299-300

How to cite this URL:
Puttaswamy RK, Jagadeesan MK. Stress fracture of the femoral neck in a military recruit. Saudi J Sports Med [serial online] 2015 [cited 2019 Jul 19];15:299-300. Available from: http://www.sjosm.org/text.asp?2015/15/3/299/164322


  Introduction Top


Stress fractures of the femoral neck account for only 5% of all the stress fractures. [1] A strong suspicion is needed, especially when treating appropriate risk population such as military recruits and athletes. The incidence of Stress fractures in military recruits is about 4-5%. [2] Stress fractures occur in individuals in whom repetitive strenuous muscle forces act on bone that have not adapted to such forces. In normal remodeling, osteoclast resorption and osteoblastic reconstruction of bone are in equilibrium under a constant load. If loading increases, additional bone resorption occurs. Increased osteoclastic activity at sites of stress may cause local weakening and predispose to micro damage. If allowed to progress, such micro-fractures may progress to complete fractures. Need to differentiate tension stress fractures occurring superiorly, which need stabilization, as compared to compression stress fractures which can be treated conservatively. We present a case of stress fracture of the femoral neck in a military recruit treated by closed reduction and dynamic hip screw and a derotation screw.


  Case Report Top


A 25-year-old man presented with left thigh pain for 30 days without any history of significant trauma. He was a military recruit with history of running 5 miles a day for last 5 years and was running 20 miles a day for last 30 days before he developed pain. Examination revealed pain to palpation along the proximal medial and lateral left thigh. Range of motion was painful and limited. Radiograph of left hip showed fracture line in the neck of femur extending into the superior neck indicating a tension side stress fracture [Figure 1]. Since the fracture was partially displaced and in varus was planned for surgical intervention. Patient was operated with closed reduction and internal fixation with dynamic hip screw and a derotation screw [Figure 2]. Was started on partial weight bearing for 4 weeks then to full weight bearing. Serial radiographs taken showed consolidation of the fracture [Figure 3]. At 1-year patient was asymptomatic with a full range of movements of the hip.
Figure 1: Preoperative radiograph showing fracture neck of left femur

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Figure 2: Preoperative radiograph showing good reduction and fixation with dynamic hip screw and derotation screw

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Figure 3: One-year follow-up radiograph showing good consolidation of the fracture

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  Discussion Top


Stress fractures of the neck of femur are well described in the literature. Normal bone that is subjected to excessive stress can develop fatigue fractures. Bone remodels in response to repetitive submaximal stresses. With increased stress, the bone does not remodel sufficiently to accommodate for the rapid bone breakdown that can eventually lead to microfractures and stress fracture. [3] Fatigue fractures that occur in young individuals are often a result of repetitive athletic activity. Distance runners, dancers, and military recruits are commonly affected and are at an increased risk to developing stress fractures in the hip. [4]

The femoral neck is subjected to loading forces several times body weight and with stands considerable tensile and compressive forces. Tensile forces occur at the superior aspect of the femoral neck, whereas compressive forces occur at the inferior aspect. [4] Tension side femoral neck stress fractures are at higher risk of nonunion and displacement. [5] Femoral neck stress fracture has many associated complications such nonunion, malunion, avascular necrosis and arthritis. Treatment is based on the anatomic location. Tensile side fractures needs internal fixation because of their propensity for complications. Compression side fractures can be treated conservatively but needs regular radiographic evaluation to look for any displacement.


  Conclusion Top


Here we have reported a case of stress fracture of the neck of femur which was treated surgically. It's important to recognize these fractures early as there are high chances of displacement resulting in increased risk of complications. We suggest immediate anatomical reduction and stable internal fixation to prevent complications and early mobilization to decrease the morbidity.

 
  References Top

1.
Fullerton LR Jr, Snowdy HA. Femoral neck stress fractures. Am J Sports Med 1988;16:365-77.  Back to cited text no. 1
    
2.
Volpin G, Hoerer D, Groisman G, Zaltzman S, Stein H. Stress fractures of the femoral neck following strenuous activity. J Orthop Trauma 1990;4:394-8.  Back to cited text no. 2
    
3.
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;17:379-422.  Back to cited text no. 3
[PUBMED]    
4.
Egol KA, Koval KJ, Kummer F, Frankel VH. Stress fractures of the femoral neck. Clin Orthop Relat Res 1998;348:72-8.  Back to cited text no. 4
    
5.
DeFranco MJ, Recht M, Schils J, Parker RD. Stress fractures of the femur in athletes. Clin Sports Med 2006;25:89-103, ix.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Discussion
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