Femoral Neck Stress Fractures Treatment Options

What are femoral neck stress fractures?

Femoral neck stress fractures represent a significant orthopedic concern characterized by microfractures in the proximal portion of the femur (thigh bone) due to repetitive mechanical stress. These fractures primarily affect athletes and individuals engaged in high-impact activities, presenting with symptoms such as hip or groin pain, limited range of motion, and discomfort during weight-bearing. Diagnosis typically involves imaging studies like MRI, which can reveal early signs of fracture pathology. Treatment approaches vary based on the fracture’s severity, ranging from conservative measures like activity modification and immobilization to surgical intervention when warranted. Prompt diagnosis and appropriate management are essential to prevent complications and facilitate optimal recovery in individuals with femoral neck stress fractures.

What non-operative options are available?

Conservative management serves as the cornerstone of treatment for femoral neck stress fractures, particularly in cases of nondisplaced or minimally displaced fractures without signs of instability. Conservative treatment strategies aim to reduce pain, promote fracture healing, and prevent further displacement or complications. Key components of conservative management for femoral neck stress fractures include:

1. Protected Weight Bearing: Restricting weight-bearing on the affected leg and using assistive devices such as crutches or a walker can offload the injured femoral neck, reduce mechanical stress, and promote fracture alignment and union. Partial weight-bearing protocols may be initiated based on the patient’s pain tolerance and fracture stability, gradually progressing to full weight-bearing as tolerated.
2. Activity Modification: Temporary cessation of high-impact weight-bearing activities and modification of activity levels are essential to minimize stress on the affected femoral neck and facilitate fracture healing. Individuals may need to transition to low-impact exercises or non-weight-bearing activities during the initial phase of recovery to avoid exacerbating symptoms and compromising fracture stability.
3. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or analgesic medications may be prescribed to alleviate pain and discomfort associated with femoral neck stress fractures. Topical analgesic creams or gels may provide localized pain relief, particularly for individuals with superficial soft tissue tenderness or inflammation.
4. Nutritional Optimization: Adequate nutritional support, including calcium, vitamin D, protein, and micronutrient supplementation, is essential for promoting bone health and facilitating fracture healing. Dietary counseling or referral to a registered dietitian may be beneficial for individuals with nutritional deficiencies or dietary restrictions.

Conservative management of femoral neck stress fractures requires close monitoring of symptoms, radiographic progression, and functional status to assess treatment efficacy and ensure timely intervention if conservative measures fail to achieve satisfactory outcomes.

What operative options are available?

For femoral neck stress fractures unable to be treated nonoperatively, surgical interventions offer targeted treatment options for femoral neck stress fractures, particularly in cases of displaced or unstable fractures with the potential for nonunion or avascular necrosis. These procedures aim to achieve fracture reduction, restore anatomical alignment, and promote biological healing while minimizing surgical morbidity and preserving native bone and soft tissue structures. Common surgical interventions for femoral neck stress fractures include:

1. Closed Reduction and Percutaneous Fixation: Closed reduction followed by percutaneous fixation with cannulated screws or intramedullary nails may be performed to stabilize displaced femoral neck fractures and prevent further displacement. This minimally invasive technique allows for precise fracture reduction and fixation under fluoroscopic guidance, minimizing soft tissue disruption and accelerating postoperative recovery.
2. Dynamic Hip Screw (DHS) Fixation: DHS fixation involves the placement of a sliding hip screw device across the fracture site to stabilize femoral neck fractures and promote fracture healing. This procedure provides biomechanical stability and allows for controlled dynamic compression across the fracture line, facilitating fracture union and preventing implant failure.
3. Internal Fixation: Open reduction and internal fixation with compression hip screws, cannulated screws, dynamic hip screws, or sliding hip plates may be performed to stabilize displaced femoral neck fractures and restore anatomical alignment. Open reduction allows for direct visualization of the fracture site and precise fracture reduction, while internal fixation provides mechanical stability to promote fracture healing.

What does postoperative rehabilitation look like?

Postoperative rehabilitation is an integral component of the treatment regimen for femoral neck stress fractures, regardless of the chosen treatment modality. Rehabilitation protocols aim to promote fracture healing, restore hip joint mobility and strength, improve functional capacity, and facilitate return to pre-injury activity levels. Key components of postoperative rehabilitation for femoral neck stress fractures include:

1. Early Mobilization: Early mobilization and ambulation with the assistance of physical therapists or rehabilitation specialists can prevent complications such as joint stiffness, muscle atrophy, and venous thromboembolism. Gradual progression from partial weight-bearing to full weight-bearing activities is essential to prevent implant failure or fracture displacement while allowing for adequate bone remodeling and healing.
2. Range of Motion Exercises: Gentle passive and active range of motion exercises can help restore hip joint mobility, alleviate stiffness, and prevent the development of contractures or adhesions. Physical therapists may incorporate stretching, mobilization, and manual therapy techniques to improve joint flexibility and optimize functional outcomes.
3. Strengthening Exercises: Progressive strengthening exercises targeting the hip abductors, adductors, flexors, extensors, and rotators are essential for restoring muscle strength, stability, and dynamic control around the hip joint. Resistance training, functional exercises, and neuromuscular reeducation programs can enhance muscle performance, improve biomechanical efficiency, and reduce the risk of recurrent injuries.
4. Gait Training: Gait training and functional mobility exercises are crucial for reestablishing normal walking patterns, balance, and coordination following femoral neck stress fractures. Physical therapists may use assistive devices such as walkers, crutches, or canes to facilitate safe ambulation and promote independent mobility during the early stages of rehabilitation.
5. Return to Activity Progression: Gradual return to sports or high-impact activities should be guided by the patient’s clinical progress, functional status, and fracture healing response. Physical therapists, athletic trainers, or sports medicine specialists can provide individualized guidance and recommendations regarding activity modification, training progression, and injury prevention strategies to minimize the risk of recurrent fractures or complications.

Dr. Shane J. Nho is a board-certified fellowship trained sports medicine orthopaedic surgeon who specializes in the treatment of femoral neck stress fractures. If you believe you are affected by a femoral neck stress fracture, schedule a consultation today with our experienced orthopaedic care team.