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5 successive X rays (every 2 months) of stress fracture of the neck of the femur

Femoral neck stress fractures 

I share with you a case of femoral neck stress fracture of compression side that is less than 50 percent of femoral neck width. She is 19 years old and she is a runner. She was successfully treated conservatively with partial weight bearing as tolerated progressing to full weight bearing. She has done X ray every 2 months for 5 times. She had complete healing after 10 months which is a very long period than what was expected of 3-4 months.
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Review of literature 
Incidence
They account for 3% of all sport related stress fractures. 

Cause
It commonly occurs in marathon runners followed by gymnasts, ice skaters and ballerinas.

Types
The main types are compression type, tension type and displaced type. 

Symptoms 
The most common  symptom is groin pain.

Signs
The most obvious sign is localized bony tenderness

Can the patient walk ??
All patients should stop running and jumping sports for 6 weeks. If there is any pain with weight bearing or night pain, crutches will be required for 3 weeks.

What is the gold standard radiological investigation?
X ray may show Lucent line or maybe negative. MRI is both sensitive and specific. 

How long does it take to heal?
About 12 weeks.

What is the main treatment? 
The maint treatment for femoral neck stress fractures of compression side if less than 50 percent of femoral neck width is rest from the offending athletic activity, and partial weight bearing if it can be tolerated or non weight bearing for 3-6 weak then progressive weight bearing.

Operative treatment by 3 (6.5 or 7.3 mm)  cannulated screws if tension side fracture or compression side if more than 50 percent of femoral neck width.









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