Stress Fractures of the Hip and Pelvis

Hip Region Stress Fracture in South Korean Military Recruits: Private's Fracture

INTRODUCTION

This study aims to analyze the characteristics of hip region stress fractures (HSFs) within a South Korean military cohort and identify the associated risk factors to provide insights for treatment and prevention strategies. Additionally, we will report the epidemiologic data and clinical outcomes of treating HSF within the second largest military hospital.

MATERIALS AND METHODS

Between January 2022 and December 2023, this retrospective case series revised all HSF patients' medical records to analyze demographic and epidemiologic data and clinical progress. The incidence rate was calculated using the number of conscripted soldiers based on publicly open available statistics from government institution.

RESULTS

A total of 95 hips from 60 patients were included in this study, and 35 patients (58.3%) exhibited bilaterality. The seasonal variation of HSF patients showed a bimodal distribution, with peaks from April to June and October to December. The incidence rate per 100,000 person-years is estimated to be between 55.3 in 2022 and 67.9 in 2023.

CONCLUSIONS

Hip region stress fractures can also be termed as "private's fractures," which accurately describe their nature. It is crucial to identify cases that necessitate early diagnosis and surgical intervention. Epidemiologically, HSF demonstrates high bilaterality and a bimodal distribution throughout the year. During this period, unit commanders and military doctors should be cautious of HSF among soldiers and conduct appropriate screenings.

Cephalomedullary Nail Fixation for Prophylactic Treatment of Incomplete Femoral Neck Stress Fractures in Athletes

Background

The traditional management of femoral neck stress fractures (FNSFs)-such as cannulated screw fixation-requires a period of protected weightbearing and does not provide fixed angle stability.

Purpose

To report the technique and outcomes of a single surgeon's case series of prophylactic fixation of incomplete FNSFs using cephalomedullary nailing (CMN) followed by immediate weightbearing.

Study Design

Case series; Level of evidence, 4.

Methods

A retrospective review of 17 FNSFs treated using CMN by a single surgeon over 7 years was conducted. descriptive, injury, and treatment-related data were collected. Perioperative complications and recovery courses were included for each case. Descriptive statistics were used to summarize the characteristics, clinical presentation, diagnostic imaging findings, treatment details, and follow-up outcomes of the study population.

Results

There were no perioperative complications across the 17 injuries. The mean intraoperative blood loss was 67 mL (range, 20-150 mL). In all 17 cases, immediate full weightbearing was recommended. All patients were able to initiate a return to running by 6 weeks postoperatively. Time until completion of narcotic use was noted for 15 cases, with narcotic medications no longer required at 2 weeks for 12 injuries (71%), at 6 weeks for 2 injuries (12%), and at 3 months for 1 injury (5.9%). Patients had a mean of 12.4 months of follow-up (range, 6-48 months). At the final follow-up, 5 cases (29%) had persistent pain-1 from gluteus medius tendinosis and 4 from painful distal interlocking screws. Two patients underwent the removal of symptomatic hardware.

Conclusion

This study demonstrated that prophylactic fixation of FNSFs with CMN in endurance athletes is a safe and effective construct that permits early return to baseline impact activity because of the inherent stability of the construct, with a favorable complication profile-although with a 30% rate of persistent pain from the surgical site.

Lateral femoral neck stress fractures: A case report

BACKGROUND

Sport-induced injuries particularly affect young, healthy, and active individuals. Running, a popular and accessible sport, can cause a wide range of injuries, including stress fractures. Stress fractures can occur during high-intensity training or competitions, especially among well-trained amateurs and professional athletes. Adequate diagnosis can be complicated by the typically young age, unremarkable medical history, and vital condition of the patient. Stress fractures present insidiously, and this is specifically the case with stress fractures of the femoral neck. Timely intervention is crucial to prevent progressive displacement, as this can damage the blood supply to the femoral head.

CASE SUMMARY

A 30-year-old male runner presented to our outpatient clinic with persistent pain 3 weeks after running a marathon. X-ray showed a complete lateral fracture of the left femoral neck, which was treated surgically with a dynamic hip screw.

CONCLUSION

It is essential for healthcare providers to be vigilant for the subtle symptoms of stress fractures to ensure timely treatment. Early recognition prevents complication and leads to a better prognosis.

Case 326: Intra-Articular Osteoid Osteoma

HISTORY

A 15-year-old male patient presented with a 3-week history of inner left thigh pain provoked by activity and experienced occasionally at rest. The patient denied nighttime pain, fever, or chills. Laboratory investigation revealed the following normal values: hemoglobin level of 15.6 g/dL (normal range, 13-16 g/dL), platelet count of 240 × 103/µL (normal range, 140-440 × 103/µL), and total leukocyte count of 7100 cells/µL (normal range, 4500-11 000 cells/µL). The percentage of neutrophils was considered low at 44% (normal range, 54%-62%), and the percentage of eosinophils was slightly high at 3.7% (normal range, 0%-3%). An anteroposterior radiograph of the left hip is shown. Physical therapy was initiated, with no improvement after 2 weeks of therapy. The patient was referred to an orthopedist for further evaluation. At physical examination, the patient endorsed marked left hip pain with hip flexion to 90°, limited internal and external rotation (5° and 15°, respectively), and antalgic gait favoring the left leg. Hip MRI and further serologic analysis were requested for further evaluation. Although the serologic testing was performed at an outside laboratory, the physician reported positive immunoglobulin-G Lyme titers, normal C-reactive protein level, and normal erythrocyte sedimentation rate. Pelvic CT was requested. The patient was prescribed a course of doxycycline (100 mg twice daily for 28 days), with reported resolution of symptoms 2 weeks after initiation of treatment. Three weeks later, the patient presented to our department with recurrent left hip pain, which was similar in severity compared with the initial presentation. A second MRI examination of the left hip was performed 4 months after the initial presentation.

Stress Fracture after Arthroscopic Lesser Trochanter Resection: Diagnosis and Therapy

We report on the case of a 52-year-old female who presented with a stress fracture after undergoing an endoscopic resection of the lesser trochanter in ischiofemoral impingement, which was resistant to maximal conservative treatment. To the best of our knowledge, this complication has not been previously described. Non-weight-bearing and intravenous alendronic acid were prescribed for management. No additional surgery was required. The patient was pain free with the ability to perform sports on the same level as before and had no complaints.

Imaging of common hip pathologies in runners

Running is an increasingly popular sport and form of exercise. Because of the importance of the hip in the biomechanics involved with running, forming the primary connection between the axial and appendicular skeleton of the lower extremities, accurate diagnosis and reporting of hip pathology are vital for appropriate management. This review provides an overview of the most common hip pathologies and injuries encountered in runners. Radiologic studies, primarily conventional radiography and magnetic resonance imaging (MRI) provide useful diagnostic information and should be used in combination with clinical findings to help guide therapeutic management.