Review Question - QID 1377

The patient's history and imaging are consistent with a femoral neck stress fracture. While most compression-sided fractures may be treated non-operatively with protected weightbearing, percutaneous screw fixation is indicated for tension-sided fractures and compression-sided fractures that extend greater than 50% of the way across the neck, as in this case.

The fracture is not evident on the pelvis radiograph but is visualized on the bone scan, T1, and T2 MR images. Bone density is not an important consideration in the decision to surgically treat a stress fracture of the hip, however whether the stress fracture is compression versus tension-sided is important. A visible fracture line on radiographs obviates the need for a MRI and increases the likelihood of displacement being present. Displaced femoral-neck fatigue fractures are urgent surgical situations.

The review article by Shin et al suggest that tensile forces at a stress-induced fracture often lead to poor healing and require aggressive operative treatment to avoid osteonecrosis, malunion, and coxarthrosis. The authors also suggest that compression-sided fracture that involves >50% of the neck (as demonstrated in this case) should have strong consideration for operative fixation or alternatively be placed on strict nonweightbearing with weekly radiographs to evaluate for displacement.