Femoral Neck Stress Fx

Question 1

Pt populations

Answer 1

Female athlete triad
Postmenopause
Low BMD
High intensity training

Question 2

Risk factors

Answer 2

Hx of stress fx anywhere.
Osteoporosis.
Bone cancers.
Radiation therapy.
RA.
Prolonged corticosteroid use.
Pegets Disease.
Renal failure.
Smoking.

Question 3

MOI

Answer 3

insidious onset
recent ↑ in training

Question 4

Pain

Answer 4

Groin, deep anterior hip.
C-Sign.
Pain may go down into thigh/knee.
Consider hip fx if knee pain & not finding anything dx in knee.

Question 5

Aggs

Answer 5

Unilateral WB/hopping
Night pain
intense physical activity.

Question 6

ROM limitations

Answer 6

Flex, IR, ext
(non-capsular)

Question 7

Special tests

Answer 7

Fulcrum.
Patellar-Pubic Percussion.
Hop test - repeated hop, pain?
Heel strike test - walking, pain on heel strike?

Question 8

Non-surgical tx: acute phase

Answer 8

Wks 2-4
Rest, limit activity that caused it.
Strength & ROM both need to be NWB.

Question 9

Non-surgical tx: recovery phase

Answer 9

Wks 6-8
Strength - still NWB or lesser WB (swimming, cycling). Progress WB as pain allows.
ABDuctors & flexors; knee flex/ext.

Question 10

Non-surgical tx: maintenance phase

Answer 10

Wks 8+
Eccentric strengthening, sport-specific training.

Question 11

Surgery indicated for

Answer 11

Displaced.
Complete (with or without displacement).
Incomplete, tension-side.
Incomplete, compression-side.

Question 12

Surgery for displaced & post-op rehab

Answer 12

More invasive, more hardware implanted.
THR if older pt.
NWB, increase by 25% per wk.
Full WB in 10-12 wks.

Question 13

Surgery for non-displaced & post-op rehab

Answer 13

Screw fixation.
WBAT, normalize gait in 1st mo