FEMORAL STRESS FRACTURES
Section snippets
ORIGIN
Stress fractures may occur when there is an imbalance between bone injury and bone remodeling. Bone reacts to stress by early osteoclastic activity followed by strengthening osteoblastic activity.11 An abrupt increase in the duration, intensity, or frequency of physical activity without adequate periods of rest may lead to excessive osteoclastic activity. The exact mechanism responsible for initiating stress fractures remains unclear. One theory holds that excessive forces are transmitted to
DIAGNOSIS
Early diagnosis, especially for femoral neck stress fractures, is critical for avoiding complications and returning the athlete to play as soon and as safely as possible. The onset of pain is gradual over a period of days to several weeks. Symptoms are usually aggravated by exercise and relieved with rest. Localizing the point of maximal tenderness may be more difficult in the femur than other lower extremity bones because of the large soft-tissue envelope. Stressing the femur via gentle
TREATMENT
The treatment of stress fractures depends on the underlying causes responsible for initiating the injury. Extrinsic factors, such as the training regimen, as well as intrinsic conditions, such as nutritional, hormonal, and medical abnormalities, need to be assessed. Training errors are the most frequent cause of stress fractures. These injuries can be appropriately treated by rest followed by a gradual resumption to activity. Medical evaluation is considered for any patient with increased risk
FEMORAL NECK STRESS FRACTURES
In a retrospective review of 320 athletes with stress fractures confirmed by bone scan, Matheson14 found the femur (7.2%) to be the fourth most common site of injury. Only those of the tibia (49%), tarsals (25.3%), and metatarsals (8.8%) were more prevalent in the athletic population. More recently, Johnson et al10 prospectively followed 914 athletes from 20 collegiate varsity teams. They reported 7 of 34 stress fractures (20.6%) to occur in the femoral shaft. Stress fractures of the femur have
FEMORAL CONDYLE STRESS FRACTURES
There are few published case reports of femoral condylar stress fractures.12, 15, 18 Despite the apparent rarity of this injury, the incidence may actually be underestimated. Stress fractures may be overlooked in favor of other soft-tissue diagnoses around the knee or avascular necrosis of the femoral condyles. Abnormal bone scans of the knee are often nonspecific, with a long differential including injuries to the growth plate or ligaments, osteochondritis dissecans, or osteonecrosis. MR
SUMMARY
Stress fractures are common overuse injuries attributed to the repetitive trauma associated with vigorous weightbearing activities. A high index of suspicion is necessary to diagnose stress fractures of the femur because the symptoms may be vague. The precipitating factors, whether related to training errors or medical conditions, should be thoroughly evaluated. Early diagnosis of distraction femoral neck stress fractures is critical to avoid serious complications. Femoral shaft stress
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Cited by (55)
Proximal femur shaft fracture in a case of ipsilateral resection arthroplasty of a tuberculous hip - A rare case report
2022, Journal of Clinical Orthopaedics and TraumaCitation Excerpt :Dunn et al. performed closed reduction with intramedullary internal fixation by nail but faced problems of reduction achievement and canal preparation by reaming.4 We disregarded the idea of retrograde nailing due to the proximal location of femur shaft fracture, along with the concerns of opening the knee joint and risking it to arthritis in the future.7 And so we chose plate fixation as the modality of treatment in our case with advantage of achieving a stable fixation and as the pseudoarthrosis site was undisturbed the patient returned to pre operative ambulatory status due to early initiation of joint mobilization.
Hip Anatomy and Biomechanics
2021, The Female AthleteFemur and Pelvis Fractures
2011, Fracture Management for Primary Care, Third EditionFemoral Neck Stress Fractures
2009, Operative Techniques in Sports MedicineCitation Excerpt :Conservative management is suggested for patients with compression side fractures,2 although, anecdotally, we are aware that some surgeons suggest a minimally invasive surgical approach for these fractures at presentation, to avoid prolonged periods of reduced or no weight bearing, and loss of training time. A classification on the basis of radiographic appearance16 includes the following: type 1 fractures: MRI-positive fractures, and endosteal or periosteal callus without an overt fracture line at radiographs; type 2 fractures: a nondisplaced fracture line at radiographs; type 3 fractures: displaced fracture line at radiographs. SFFN are generally considered high-risk fractures.2
Leg injuries
2007, Clinical Sports MedicineManagement of Femoral Neck Stress Fractures
2006, Operative Techniques in Sports Medicine
Address reprint requests to Kevin P. Speer, MD, Department of Orthopedics, Sports Medicine Section, Duke University Medical Center, Durham, NC 27710
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Department of Sports Medicine, Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina