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A femoral neck stress fracture in a skeletally immature individual is a rare event. To our knowledge, only fourteen cases have been reported in the literature1-5. Several authors have devised systems to classify these fractures2,3,6. Stress fractures usually show no initial fracture line radiographically but rather demonstrate a gradual alteration of the trabeculae due to repetitive or overuse activity6. As a result, the diagnosis of stress fracture is infrequently considered when a child presents with a limp along with persistent or recurring pain in the hip, the anterior portion of the thigh, or the knee. To our knowledge, the few cases that have been reported in the literature have all occurred on the compression (medial) side of the femoral neck1-5. Blickenstaff and Morris stated that only compression-sided stress fractures can occur in children6.
Most compression-sided stress fractures heal after being treated with limited weight-bearing and restriction of activity1-5,7. In adults, however, femoral neck stress fractures often lead to complications, including displacement, malunion, nonunion, osteonecrosis of the femoral head, and infection8. Relatively few complications have been associated with femoral neck stress fractures in skeletally immature individuals. St. Pierre et al. reported on two femoral neck stress fractures that required surgery after the failure of nonoperative treatment7. The first fracture was initially treated with limited weight-bearing and modification of activity, but a nonunion subsequently developed and required internal fixation. The second fracture also was initially treated nonoperatively, but it became displaced and required immediate closed reduction and internal fixation.
The development of stress fractures in children has been attributed to the rapid onset of stress changes with microtrauma combined with the inability of the bone to remodel or heal in a timely manner7,9,10. Blickenstaff and Morris reported a decrease in the absorption effect of the abductor musculature6. Others have described a sequence of events initiated by muscle fatigue with a compensatory alteration of gait pattern7,10. We present the case of a fourteen-year-old boy with open physes who sustained a tension-sided (lateral) femoral neck stress fracture while playing football. Our patient and his family were informed that data concerning the case would be submitted for publication.
Case Report
A fourteen-year-old boy presented to his primary-care physician because of pain in the right hip of several weeks' duration. He...