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Answer: What is the Diagnosis?
  1. J O'Brien1,
  2. J Taunton2,
  3. J Larsen3,
  4. B B Forster1
  1. 1Department of Radiology, University of British Columbia Hospital, Vancouver, British Columbia, Canada
  2. 2Department of Sports Medicine, University of British Columbia Hospital, Vancouver, British Columbia, Canada
  3. 3Primary Care, University of British Columbia Hospital, Vancouver, British Columbia, Canada
  1. Correspondence to Dr J O’Brien, Department of Radiology, University of British Columbia Hospital, G63 Purdy Pavillion, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada; juliemobrien{at}gmail.com

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Diagnosis

Femoral neck stress fracture (FNSF), with subsequent progression to a complete fracture of the right femoral neck.

Radiographic findings

The plain radiograph of the right hip (figure 3) demonstrates sclerosis on the medial aspect of the femoral neck (arrow).

Figure 3

Radiograph of the right hip demonstrating a horizontal area of sclerosis on the medial aspect of the right femoral neck extending to the medial cortex. There is no visible fracture line.

A selective coronal image from the fat suppressed T2-weighted MRI sequence (figure 4) demonstrates an area of high T2 signal representing bone marrow oedema (arrow) on the medial aspect of the femoral neck. There is a horizontal linear area of low T2 signal within the region of bone marrow oedema, representing the stress fracture.

Figure 4

(A) Coronal magnetic resonance image from a fast spin echo T2 sequence demonstrating high T2 signal bone marrow oedema on the medial aspect of the right femoral neck with a linear area of low T2 signal within it, representing the stress fracture at this site. (B) Coronal T1-weighted magnetic resonance image, which demonstrates a horizontal linear area of low signal on the medial aspect of the right femoral neck representing a stress fracture of the medial cortex.

Discussion

Stress fractures are classified based on the condition of the underlying bone; insufficiency fractures, when a fracture occurs as result of normal stress on abnormal bone; and stress fractures, which occur when there is excessive stress on a normal bone. Remodelling is the normal response of stress on a bone, and a stress fracture occurs as result of increased remodelling and microfracture in a bone. It has been reported that stress fractures may occur in up to 15% of athletes and …

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