Posted by 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.
Femoral Neck
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.
What Now?
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.
References
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
After reading Peyton Miska-Alberts STEAM project essay I learned a lot about stress factors, particularly femoral neck stress fractures. Stress fractures are typically weight bearing injuries that are caused by repetitive movements. Many athletes are diagnosed with stress fractures because sports are high impact activities. Peyton had a stress fracture due to long distance running. She found that runners are more susceptible to getting stress fractures because running requires repetitive movements and is a weight bearing activity. The specific type of fracture Peyton had was a femoral neck stress fracture. The femur is a long bone and is often referred to as the thigh bone. The proximal end of the femur has a head and neck. The head connects to the pelvis and the neck connects the head of the femur bone to the body of the bone. The neck is both a compression and tension point for the body. If the femur undergoes too much weight it can fracture at the neck. From Peyton’s drawings I found that the femoral neck stress fracture is commonly separated into four categories. Category 1 is a partial fracture and is not displaced. Category 2 is a complete fracture all the way through the neck of the bone and is not displaced. Category 3 is a complete fracture and a small gap forms between the neck which causes an incomplete displacement. Category 4 is a complete fracture and a large gap forms between the neck which causes a complete displacement. There are different treatment options based on the severity of the fracture. A category 1 fracture requires rest and physical therapy. A category 2 fracture requires a longer period of rest, physical therapy, and sometimes surgery. A category 3 and 4 require surgery, rest, and physical therapy.
After reading Peyton Miska-Alberts STEAM project essay I learned a lot about stress factors, particularly femoral neck stress fractures. Stress fractures are typically weight bearing injuries that are caused by repetitive movements. Many athletes are diagnosed with stress fractures because sports are high impact activities. Peyton had a stress fracture due to long distance running. She found that runners are more susceptible to getting stress fractures because running requires repetitive movements and is a weight bearing activity. The specific type of fracture Peyton had was a femoral neck stress fracture.
From Peyton’s drawings I found that the femoral neck stress fracture is commonly separated into four categories. Category 1 is a partial fracture and is not displaced. Category 2 is a complete fracture all the way through the neck of the bone and is not displaced. Category 3 is a complete fracture and a small gap forms between the neck which causes an incomplete displacement. Category 4 is a complete fracture and a large gap forms between the neck which causes a complete displacement. There are different treatment options based on the severity of the fracture. A category 1 fracture requires rest and physical therapy. A category 2 fracture requires a longer period of rest, physical therapy, and sometimes surgery. A category 3 and 4 require surgery, rest, and physical therapy.
Peyton’s STEAM project was about the femoral neck and stress fractures that can occur in that area. Stress fractures can be caused by many things. Many stress fractures can be caused by or contributed to by high-impact sports. The femoral neck is a part of the femur that undergoes a lot of stress in everyday life. Any kind of exercise can make the stress level on the femoral neck go up. In most femoral stress fractures, the bone remains in its natural position, with no displacement. Femoral neck stress fractures begin on either the inferior area of the femoral neck or the superior area of the femoral neck. In most cases of Femoral neck stress fractures, there is accompanied by pain in the groin area of the patient. Usually, you would need a magnetic resonance imaging scan, more commonly referred to as an MRI scan, to diagnose a femoral neck stress fracture. There are four types of a femoral neck stress fracture. One type is the undisplaced incomplete stress fracture. In image one of Peyton’s drawings, you can see that an undisplaced incomplete stress fracture does not go all the way through the femur. It is called undisplaced because, since the break was not complete, the bone cannot be capable of moving away from the rest of the bone. The treatment for this kind of femoral neck stress fracture is a period of time without putting weight on that bone. Also, you must go for a period of time with rest to get a full recovery. The second type of femoral stress fracture is called an undisplaced complete fracture. In image two, you can see that the break of the femoral neck goes completely through the bone, but the bone remains close to the rest of the bone. There is no displacement. The treatment for this type of fracture is the same as the undisplaced incomplete fracture treatment, but with more rest time. The third kind of fracture is a complete fracture with incomplete displacement. Image 4 shows that there is a complete break, but there is a small amount of space in between the two sections of bone. Because of the severity and completion of the break, the treatment requires surgery. Also, the fourth type of femoral neck stress fracture requires surgery as treatment. This fourth type is called a complete fracture, and complete displacement. This type is the most severe. In image four, you can see the complete fracture with complete separation in the two types of bones. In the largest image, you can see where the femoral neck is, and why it is such a common place for injuries to occur. The bone is so large, that it would cause a lot of pain when fractured. Also, because it is in the leg, most sports or any kind of exercise have the potential to fracture it. Peyton’s drawings were realistic and demonstrated femoral neck stress fractures very well.