I originally stated I would be researching stress fractures and the healing process for my STEAM project. However, after conducting further research, I decided to focus on one specific area as each has a somewhat different healing time. The area of focus for this project is femoral neck stress fractures and the objective is to classify fractures. I decided on this area in particular as I have personally had a compression undisplaced incomplete femoral neck stress fracture from long-distance running.
Many Alaskans are known for being active outdoorsmen and live overall active lifestyles. The University of Alaska Fairbanks has very active sports teams from cross-country skiing to basketball. High-impact sports and activities are often fun and offer individuals enrichment. However, something is lurking just beneath the surface if proper training and precautions are not met. Vigorous high-impact activities such as running and cross-country skiing could lead to femoral neck stress fractures if one does not take the proper precautions.
The femoral neck is an area of our femur that with everyday activity is under a lot of stress to simply support our weight. If an individual is training for a sport or simply running for leisure that stress level goes up on the femoral neck. However, femoral neck stress fractures are uncommon. According to The National Library of Medicine, “Femoral Neck Stress Fractures (FNSF) are rare, representing 5% of all stress fractures, and most prevalent among runners and military recruits. Women are at higher risk in both populations with an overall incidence of stress fractures of 9.2% (vs. 3% for males) in the military and 9.7% (vs. 6.5% for males) in athletes.” Most instances of femoral neck stress fractures are undisplaced, meaning the bone retains its normal position. FNSF can begin on either the superior or inferior aspect of the femoral neck. If the fracture begins on the superior aspect, it is a tension fracture. Whereas if it is on the inferior aspect, it is a compression fracture.
Patients with femoral neck stress fractures often present with pain localized to the groin area. To test for FNSF, MRI is considered the optimal means of diagnosis because stress fractures are often not able to be visualized by x-ray alone. After a femoral neck stress fracture is confirmed by the imaging results, there are several different means of classification and the treatment plan is reliant on the classification type.
The most common method of classification is Garden’s Classification. In Garden’s Classification, there are types Ⅰ, Ⅱ, Ⅲ, and Ⅳ. Type Ⅰ is undisplaced incomplete. Type Ⅱ is undisplaced complete. Type Ⅲ is a complete fracture, incompletely displaced. Type Ⅳ is a complete fracture, completely displaced.
Treatment and Recovery
Type Ⅰ of Garden’s Classification is most often treated with non-weight bearing, rest, and physical therapy. Type Ⅱ is often treated the same as Type Ⅰ with a longer recovery time. However, depending on the severity, age, and patient lifestyle, surgical fixation (stabilizing bolts) is sometimes necessary along with a period of non-weight bearing and physical therapy. Types Ⅲ and Ⅳ both always require surgical fixation and long periods of non-weight bearing and physical therapy.
Femoral neck stress injuries: Analysis of 156 cases in a U … – home (AJR). (n.d.). Retrieved July 21, 2022, from https://www.ajronline.org/doi/pdf/10.2214/AJR.17.18639
Fonte, H., & Rodrigues-Pinto, R. (2018). Femoral neck stress fracture in a young female recruit: Case report. SICOT-J. Retrieved July 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958626/#:~:text=Femoral%20Neck%20Stress%20Fractures%20(FNSF,fractures%20of%209.2%25%20(vs.
Kazley, J. M., Banerjee, S., Abousayed, M. M., & Rosenbaum, A. J. (2018, February). Classifications in brief: Garden classification of femoral neck fractures. Clinical orthopaedics and related research. Retrieved July 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259691/
nabilebraheim. (2012, March 5). Stress fractures of the femoral neck – everything you need to know – dr. Nabil Ebraheim. YouTube. Retrieved July 21, 2022, from https://www.youtube.com/watch?v=gh02ypjc5uk07