Bilateral stress fractures of femoral neck in non-athletes: a report of four cases
2013
【Abstract】Femoral neck stress fractures (FNSFs)
are rare, constituting only 5% of all stress fractures in young
adults. These fractures are usually seen in athletes, military
recruits and patients with underlying metabolic diseases.
The treatment of FNSFs is still controversial because of the
inherent complications associated with the treatment
procedure. We came across 4 cases of bilateral FNSFs in
non-athletic individuals who were manual labourers with-out underlying bony disorders. Two patients with FNSFs
and coxa vara deformity on both sides were managed by
subtrochanteric valgus osteotomy and dynamic hip screw
fixation. One of the remaining two patients was treated by
cannulated cancellous screw fixation on one side and sub-trochanteric valgus osteotomy on the other side. The fourth
patient received subtrochanteric valgus osteotomy on one
side and bipolar hemiarthroplasty on the other side after
failed cannulated screw fixation. All the fractures healed
without any complications. No evidence of avascular ne-crosis or arthritis was noted in our series. Subtrochanteric
valgus osteotomy restores normal neck-shaft angle in pa-tients suffering from FNSFs combined with coxa vara
deformity. Moreover, it helps to bring the forces acting
around the hip to normal biomechanical levels, leading to
fracture union and better results. Replacement arthroplasty
is recommended to patients who fail to achieve bony union
after fixation.
Key words: Fractures, stress; Femoral neck fractures;
Coxa vara; Osteotomy
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