Femoral Neck Stress Fracture

[kiwibug]

So after about four weeks since initially feeling pain in my hip (I tried to turn into a runner/triathlete overnight and it didn't work out very well), a bone scan finally confirmed that I have a stress fracture in the compression side of my femoral neck.

Does anyone have any experience with this? My doctor is going to have me meet with an orthopedic surgeon to discuss getting pins put in to make sure the neck doesn't break completely, and for now I'm supposed to be on crutches so that I don't feel any pain. She said if it feels a lot better by the time I meet with the surgeon I might be able to avoid the surgery..

I'm still going bonkers with no exercise but at least I know what it is.

[bmccasland]

Seems like being on crutches and avoiding surgery is a good thing. Have they done a bone density scan? Your femur should be a big strong bone, how the heck did you get a stress fracture in that bone? :eek: Will PT help?

[OakLeaf]

Ouch. :( Heal up quick.

[ruffianxc]

usually femoral neck hip fractures don't heal without pinning unless they are on a precise location that isnt' being pulled on and stressed by muscles. thats not saying you don't have that. I'm sure your doctor knows where your fracture is at but unless they are familiar with ortho cases they may not know. At least thats how I remember it from a couple years ago.

[kiwibug]

... Really??

Ugh. I have to make a decision - I'm at school now and the soonest an orthopedic surgeon can see me is November 17th, (he's away for a week and a half), but if I try to get in to see someone at home I could see someone sooner, but that's pretty inconvenient and I don't even know if I would be able to see someone sooner.

I was reading up, and I know that I have a compression type fracture (bottom part of the neck) and it's not displaced (it's not broken the whole way through), and usually they just treat it non-operatively - with limiting the weight-bearing and activity.. So I just figured I probably wouldn't need the surgery anyways?

I don't know. It's already been four weeks (and I didn't know what it was/that I shouldn't be walking on it so I have been) and it feels a lot better.. still sore at times but I'm not limping anymore (I've stopped taking pain meds because I want to be able to feel if it's hurting).

I'm not sure about why it's happened at that bone. I think that I haven't always made sure to eat properly (that is - enough calcium), and I have had some phases over the past few years where I've been really restrictive with my diet.. I've read a bit and it seems that female athletes that fall into the athlete triad category (osteoporosis, amenorrhea, disordered eating) are susceptible to stress fractures in the femoral neck.. I don't think I've ever had a real "eating disorder" and I'm not underweight, and I've had regular menstruation with the exception of a few months this past spring when I stopped taking the pill.. I don't know. I guess it could be a combination of a few things. I've started taking calcium though, I'm only 21 so I think I have some time to fix my bone density a bit.

I haven't had a bone density scan though.. I think it would probably give me more answers.

[KnottedYet]

As long as you're getting a density scan and such, you might also want a blood antibody test run to see if you have celiac disease. It can show up as bizarre symptoms, and often ties in with unusual bone issues.

[ruffianxc]

The patient I saw with this actually was about 20 years old and had an eating disorder. I saw another girl with an eating disorder who had several stress fractures and would not stop running.

Compression type is the good type if your avoiding surgery from what I remember. No guarantee no surgery but sounds better than what I originally thought.

However it won't heal as well if you don't have good nutrition.

Unless you get a couple stress fractures I don't think they need to test you for any endocrine or immune causes as there are lot with bone problems and it is most likely just a stress fracture caused by stress and diet from what you said. Those tests can get expensive and I don't think there would be enough concern of some underlying disease as you didn't mention other fractures.

I'm a 4th year med student and I shadowed in a sports medicine clinic for 2 years. I don't know a lot but I did see this.

[KnottedYet]

[QUOTE=ruffianxc;470987]

However it won't heal as well if you don't have good nutrition.

QUOTE]

Celiac disease is a disease whose myriad symptoms are a consequence of inadequate nutrition, aided and abetted by the autoimmune issues. One of the more exciting symptoms is osteopenia/osteoporosis at an unusually young age. If someone has been restricting the diet AND has a nutrient absorption issue (like celiac disease) they could experience heightened bone fragility beyond what would be expected with just one issue.

The screen is a simple blood draw, while the patient is still eating their average diet.

[KnottedYet]

I'm a 4th year med student and I shadowed in a sports medicine clinic for 2 years. I don't know a lot but I did see this.

It's amazing; the longer I practice, the less I know.

One valuable thing I've learned over the years: a patient will present with one problem, but most of the time that one problem has more than one cause. Patients with only one issue don't come in, their body copes so they don't seek medical help. When the body starts juggling multiple issues, it begins to drop things, and that's when problems show up.

I cringe when I think of the patients I misled and the issues I missed. And in all honesty, I'm probably still misleading and missing. That's why it's called "practice." ;)

[ruffianxc]

Yeah I understand you could get celiac screening, I've just never seen people get screening tests for a stress fracture. I would imagine if you noticed nonunion or repetitive fracturing it would be a good idea. All of my experience with stress fractures are pediatric/ college age kids who are generally healthy can have no other complaints so we never really have high suspicion of these things. I guess I'd think you'd be getting a lot of blood work and in addition to the cost of the test if you tested all stress fractures you'd have to deal with the cost of false positives or further work up. Additionally if you got celiac would you have to get all the other possible things that could be causing osteopenia.

I am doing metabolic bone research this year, taking the entire year off in the lab, and after reading so much about bone disease I just would wonder if you did decide to look into celiac disease, as you thought you had high enough suspicion of it, wouldn't you be obligated to look into at least some other common ones. That would be a lot to do on every stress fracture.

Interesting though.


Yeah practice is interesting. I guess you can only do the best you can do with what you got: the knowledge and judgement you had at that moment.

I agree with what your saying about complex problems and sometimes people come in saying they are worried about x and really they are worried about something else entirely but they didn't want to say it. :confused:

As of now I want to go into sports medicine so these questions I find interesting.