Femoral Neck (Hip) Stress Fracture

ExitCare ImageA hip (femoral neck) stress fracture is a complete or incomplete break in the thighbone, near the hip joint. Intense exercise or repeated stress on the leg causes wear and injury to the bone, which eventually exceeds the bone's strength. This results in the bone breaking, and is called a stress fracture. A femoral neck stress fracture may occur in both hips. However, it commonly occurs on one side.

SYMPTOMS

  • Vague, diffuse pain or ache in the groin, thigh or knee.

  • Pain that gets worse when standing on the affected leg, and with exercise.

  • Limping.

  • Limited motion of the hip.

  • Occasional tenderness around the hip and groin.

CAUSES

A stress fracture occurs when repeated injury (trauma) weakens a bone, to the point where it can no longer withstand the pressure. For a stress fracture to occur, the injuries must occur faster than the bone can heal itself.

This often follows a change in training or performance schedule, equipment, or intensity of activity. A woman's menstrual period may also impair a bone's ability to heal, resulting in a higher risk for stress fracture.

RISK INCREASES WITH:

  • Military recruits, distance runners, and triathletes.

  • Previous or current bone abnormality (i.e. osteoporosis or tumors).

  • Metabolism disorders or hormone problems.

  • Nutritional deficiency or disorders (i.e. anorexia and bulimia).

  • Loss of, or irregular menstrual periods in women.

  • Poor strength and flexibility.

  • Sudden increase in the duration, intensity, or frequency of physical activity.

  • Running on hard surfaces.

  • Poor leg and foot alignment, including flat feet.

  • Inadequate footwear with poor shock absorbers.

  • Poor exercise technique.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Muscle strength.

  • Endurance and flexibility.

  • Cardiovascular fitness.

  • Wear proper footwear. Change shoes after 300 to 500 miles of running.

  • Learn and use proper exercise technique.

  • Increase activity and training gradually.

  • For women with irregular menstrual periods, treat hormonal problems (such as with birth control pills).

  • Correct metabolism and nutrition disorders.

  • For runners with flat feet, wear cushioned arch supports.

PROGNOSIS

This condition is usually curable within 3 to 6 months, with proper treatment.

RELATED COMPLICATIONS

  • A complete fracture that shifts out of alignment (displaced fracture).

  • Bone death, due to interrupted blood supply to the ball of the hip.

  • Failure of bone to heal (nonunion).

  • Bone heals in a poor position (malunion).

  • Recurring stress fracture.

  • Risks of surgery, including infection, bleeding, injury to nerves (numbness, weakness, paralysis), and need for further surgery.

  • Stress fracture in a different site. (Occurs in 1 of every 10 patients.)

TREATMENT

Treatment first involves ice and medicine to reduce pain and inflammation, and stopping activities that aggravate your symptoms. It is advised that you use crutches for 4 to 8 weeks, to reduce the chance of causing a displaced fracture. If a menstrual, hormonal, or nutritional problem is present, it must be addressed with your caregiver and treated properly. In certain cases, bone growth stimulators may be recommended. After the prescribed period of rest, it is important to return to activity gradually. Many patients find physical therapy helpful for maintaining and regaining strength in the affected area. For serious cases, where the bone will not heal properly, surgery is needed.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Stronger pain relievers may be prescribed by your caregiver. Use only as directed and only as much as you need.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • The following occur after restraint or surgery. ( Report any of these signs immediately ):

  • Swelling above or below the fracture site.

  • Severe, persistent pain.

  • Blue or gray skin below the fracture site, especially under the toenails. Numbness or loss of feeling below the fracture site.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)