A systematic review, following strict inclusion criteria, identified 32/48 low and 16/48 high-performance runners with stress fractures of the femoral neck. Surgical treatment was performed in 33/48 cases and was significantly higher (p = 0.009) in high-performance runners. Among the 28/48 runners who resumed running, there were significantly more lower-performance runners (23/32) than higher-performing runners (5/16) (p = 0.012) and significantly more non-displaced (22/30) than displaced fractures (6/18) (p = 0.014). Complicated cases showed significantly less favourable follow-up results (p = 0.036). A significantly shorter (p = 0.032) diagnostic time for evaluation occurred with a previous history of a stress fracture or a relevant comorbidity. Stress fractures of the femoral neck represent an incisive incident for runners, and early consideration in the differential diagnosis of hip pain is required to avoid potential long-term sequelae and suboptimal function.





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