Femoral Neck Stress Fractures in Military Personnel

Abstract

Introduction: Stress fractures are common during military training but femoral neck stress fractures
are uncommon and sometimes pose diagnostic and therapeutic challenges. An incomplete stress
fracture with excellent prognosis, if left unprotected, can lead to displaced femoral neck fracture with
almost 63% complication rate even with best of the treatment. The aim of this study was to analyze
various aspects of the femoral neck stress fracture so that early diagnosis can be made to prevent
devastating complications like osteonecrosis and non-union.
Methods: The four year army hospital record of 16 patients with femoral neck stress fracture were
studied. Their demographic profi le, type of fracture, presentation delay, on set of clinical symptoms
and complication of femoral neck stress fracture were critically analyzed.
Results: The mean age of the patient was 19.94 years. Total 74% of them developed fi rst symptoms of
stress fracture between four to seven weeks of training. There was 3.4 weeks delay from the clinical
onset of symptoms to the diagnosis of stress fracture. The type of femoral neck stress fracture were
compression (31.25%), tension (18.75%) and displaced (50%). Out of eight displaced type of fractures,
5 (62.5%) had developed complications (3 osteonecrosis and 2 nonunion).
Conclusions: Femoral neck stress fracture occurs in initial four to seven weeks of training. The
high index of suspicion in initial period of training can help to detect and decreases significant
morbidity.
Key Words: displaced stress fractures, non-union, osteonecrosis, recruits