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Surgical treatment of displaced stress fractures of the femoral neck in military recruits: a report of 42 cases

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Abstract

Background

Stress fracture of the femoral neck (SFFN) is one of the severe complications of military training. Displaced SFFN may result in avascular necrosis of the femoral head (AVNFH). The purpose of this study was to evaluate the results of surgical treatment of the displaced SFFN.

Methods

Forty-two patients with displaced SFFN requiring internal fixation were treated with compression hip screw (17 cases) or multiple cancellous screws (25 cases). Forty-two patients were followed for an average of 5.6 years after operation. At the follow-up evaluation, routine radiographs were used to evaluate the fracture alignment and healing, and bone scan was used for fractures that were suspected of AVNFH. The functional assessments described by Arnold et al. were used to evaluate the functional results of surgical treatment.

Results

Seven (28%) of the 25 patients treated with multiple cancellous screws developed AVNFH during the period of follow-up. Of these seven patients, five were treated with prosthetic replacement and two treated with core decompression and bone graft. Three (17.6%) of the 17 patients treated with compression hip screw had AVNFH, and they were all treated with prosthetic replacement. The mean duration between fracture and surgery was significantly longer in patients with AVNFH (5.9 days) than in patients without AVNFH (1.9 days)(P<0.05). Five (71.4%) of the seven patients who presented a varus alignment of the femoral neck developed AVNFH later, and only five (14.3%) of the 35 patients who presented with anatomic or valgus alignment of the femoral neck developed AVNFH during the period of follow-up. Of the 42 patients, 30 (71.4%) had good functional results, four (9.5%) had acceptable and eight (19%) had poor results at the end of evaluation.

Conclusion

Delayed treatment and postoperative varus alignment were major factors contributing to AVNFH in our series. Early treatment and anatomical fixation of displaced SFFN are essential for diminishing the risk of AVNFH development.

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References

  1. Arnold WD, Lyden JP, Minkoff J (1974) Treatment of intracapsular fractures of the femoral neck. J Bone Joint Surg [Am] 56:254–262

    Google Scholar 

  2. Blair B, Koval KJ, Kummer F, Zuckerman JD (1994) Basicervical fractures of the proximal femur. A biomechanical study of 3 internal fixation techniques. Clin Orthop 306:256–263

    PubMed  Google Scholar 

  3. Blickenstaff LD, Morris JM (1996) Fatigue fracture of the femoral neck. J Bone Joint Surg [Am] 48:1031–1047

    Google Scholar 

  4. Clark DI, Crofts CE, Saleh M (1990) Femoral neck fracture fixation. Comparison of a sliding screw with lag screws. J Bone Joint Surg [Br] 72:797–800

    Google Scholar 

  5. Daffner RH (1978) Stress fractures: current concepts. Skeletal Radiology 2:221–229

    Google Scholar 

  6. Daffner RH, Pavlov H (1992) Stress fractures: current concepts. AJR 159:245–252

    CAS  Google Scholar 

  7. Devas MB (1965) Stress fractures of the femoral neck. J Bone Joint Surg [Br] 47:728–738

    Google Scholar 

  8. Egol KA, Koval KJ, Kummer F, Frankel VH (1998) Stress fractures of the femoral neck. Clin Orthop 348:72–78

    PubMed  Google Scholar 

  9. Fullerton LR, Snowdy HA (1988) Femoral neck stress fractures. Am J Sports Med 16:365–377

    PubMed  Google Scholar 

  10. Garden RS (1971) Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg [Br] 53:183–197

    Google Scholar 

  11. Greaney RB, Gerber FH, Laughlin RL (1983) Distribution and natural history of stress fractures in U.S. marine recruits. Radiology146:339–346

  12. Hajek MR, Noble HB (1982) Stress fractures of the femoral neck in joggers. Case reports and review of the literature. Am J Sports Med 10:112–116

    CAS  PubMed  Google Scholar 

  13. Johansson C, Ekenman I, Tornkvist H, Eriksson E (1990) Stress fractures of the femoral neck in athletes: the consequence of a delay in diagnosis. Am J Sports Med 18:524–528

    CAS  PubMed  Google Scholar 

  14. Manninger J, Kazar GY, Fekete GY, Nagy E, Zolczer L, Frenyo S (1985) Avoidance of avascular necrosis of the femoral head following fractures of the femoral neck, by early reduction and internal fixation. Injury 16:437–448

    PubMed  Google Scholar 

  15. Manninger J, Kazar G, Fekete G, Fekete K, Frenyo S, Gyarfas F, Salacz T, Varga A (1989) Significance of urgent (within 6 h) internal fixation in the management of fractures of the neck of the femur. Injury 20:101–105

    PubMed  Google Scholar 

  16. Mendez AA, Eyster RL (1992) Displaced nonunion stress fracture of the femoral neck treated with internal fixation and bone graft. A case report and review of the literature. Am J Sports Med 20:230–233

    CAS  PubMed  Google Scholar 

  17. Protzman RR, Burkhalter WE (1976) Femoral-neck fractures in young adults. J Bone Joint Surg [Am] 58:689–695

    Google Scholar 

  18. Sjolin SU, Eriksen C (1989) Stress fracture of the femoral neck in military recruits. Injury 20:304–305

    CAS  PubMed  Google Scholar 

  19. Stoneham MA, Bchir MB, Morgan NV (1991) Stress fractures of the hip in Royal Marine recruits under training: a retrospective analysis. Br J Sports Med 25:145–148

    CAS  PubMed  Google Scholar 

  20. Stromqvist B, Brismar J, Hansson LI, Palmer J (1984) Technetium-99m-methylenediphosphonate scintimetry after femoral neck fracture. A three-year follow-up study. Clin Orthop 182:177–189

    PubMed  Google Scholar 

  21. Visuri T, Vara A, Meurman K (1988) Displaced stress fractures of the femoral neck in young male adults: a report of twelve operative cases. J Trauma 28:1562–1569

    CAS  PubMed  Google Scholar 

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Acknowledgements

No author or related institution has received any financial benefit from research in this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, No.325, ChengKung Rd, Sec 2, Neihu, Taipei, Taiwan, R.O.C.

    C.-H. Lee, K.-H. Chao, J.-L. Jean & S.-S. Wu

  2. Department of Diagnostic Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.

    G.-S. Huang

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  1. C.-H. Lee
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  2. G.-S. Huang
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  3. K.-H. Chao
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  4. J.-L. Jean
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  5. S.-S. Wu
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Correspondence to C.-H. Lee.

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Lee, CH., Huang, GS., Chao, KH. et al. Surgical treatment of displaced stress fractures of the femoral neck in military recruits: a report of 42 cases. Arch Orthop Trauma Surg 123, 527–533 (2003). https://doi.org/10.1007/s00402-003-0579-8

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