Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Stress Fracture of the Femur Neck

SYMPTOMS

Gradual or acute onset of diffuse or localised exercise-induced pain in the groin.

AETIOLOGY

Stress reaction from excessive jumping or running exercises. Stress fractures in the femur neck are not as typical in osteoporotic or osteopenic patients as pelvic fractures. The location and type of fracture is important for the outcome: tension-side fractures may displace and cause major damage to the hip, leading to hip replacement in young athletes.

CLINICAL FINDINGS

The athlete limps. There is pain on hip rotation and compression. Jumping and running on hard surfaces aggravates the symptoms. Secondary muscular symptoms around the groin are common.

INVESTIGATIONS

This injury is often initially missed. If it is suspected, an X-ray may show the fracture. MRI will show localised bone oedema. CT can show the fracture line.

TREATMENT

This injury must be treated with utmost care and the patient should not bear weight until the fracture is healed. Tension-side fractures should be operated on.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon for consideration of surgery. If no surgery is indicated or after surgery, refer to physiotherapist for planning of a three to six months’ return programme back to full sport.

EXERCISE PRESCRIPTION

Cycling and water exercises are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs and healing on X-ray.

DIFFERENTIAL DIAGNOSES

It is important to be aware that different conditions can cause these symptoms.

PROGNOSIS

Excellent-Good if the diagnosis is made early and if it is a side compression fracture, but poor if it is missed or if it is a tension-side fracture. Many tension-side fractures lead to displacement and, later, hip replacement.

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