The association between anterior femoroacetabular impingement and femoral neck fractures: An observational study

Uncommon Twist: Femoral Neck Stress Fracture in a High-Performance Athlete With an Incidental Diagnosis of Femoroacetabular Impingement

Femoral neck stress fractures (FNSFs) are rare but significant injuries, often leading to delayed diagnosis due to nonspecific symptomatology. This case report presents a 30-year-old professional surfer who experienced acute groin pain during a half marathon, ultimately diagnosed with a left intertrochanteric line femur stress fracture and with femoroacetabular impingement (FAI) in the opposite hip. Despite being physically fit, his presentation challenges the prevailing notion that FNSFs predominantly occur in military personnel or the elderly. The patient underwent surgical left hip osteosynthesis without complications. This case highlights the importance of early suspicion of FNSFs in young, active individuals and emphasizes the need for comprehensive evaluation to prevent complications like osteonecrosis and malunion. It underscores the value of a broad differential diagnosis and timely intervention in optimizing outcomes, especially in the context of rising high-impact sports participation.

Clinical value of quantitative parameters of MSCT in the diagnosis of occult femoral neck fractures

To explore the clinical value of quantitative parameters of multi-slice computer tomography (MSCT) in the diagnosis of occult femoral neck fractures.The clinical data of 94 patients with suspected occult femoral neck fractures admitted to our hospital from April 2021 to April 2022 were selected for retrospective analysis, and they were divided into group A (accurate diagnosis, n = 63) and group B (non-occult femoral neck fractures, n = 31) according to the results of pathological and surgical diagnosis as the gold standard. All patients received MSCT examination to obtain quantitative parameters related to imaging, and receiver operator characteristic (ROC) curves were used to comprehensively evaluate the clinical value of quantitative parameters of MSCT in the diagnosis of occult femoral neck fractures.The quantitative parameters of MSCT in group A were overtly lower than those in group B (P < 0.05). The AUC value, Youden index and sensitivity of the combined detection were higher than those of single detection.The use of quantitative parameters of MSCT effectively reduces the missed diagnosis rate of occult femoral neck fractures, which could make an accurate diagnosis of the fracture type, as a basis for the formulation of clinical treatment plans.

Acetabular cartilage abnormalities in elderly patients with femoral neck fractures

INTRODUCTION

Both hemiarthroplasty (HA) and total hip arthroplasty (THA) are widely accepted surgical procedures for hip replacement following displaced femoral neck fractures. However, in cases involving an intact joint line before surgery, the choice between HA and THA remains debatable. This study investigated the prevalence of acetabular cartilage and labral abnormalities in elderly patients with femoral neck fractures.

METHODS

Thirty-seven patients underwent hip arthroplasty for femoral neck fractures between April 2020 and February 2021. After excluding 4 patients, 33 patients (6 men and 27 women; mean age = 82.2 [range = 67-98] years) with fractures in 12 left and 21 right hips were included. After femoral head removal during arthroplasty, the acetabulum was macroscopically examined for the presence of cartilage and labral lesions. Acetabular cartilage abnormalities were classified as either overall degeneration or partial damage according to the cartilage damage classification system.

RESULTS

Acetabular cartilage abnormalities, including overall degeneration or partial damage, were found in all hips (100%). Out of the 33 hips, overall degeneration, partial damage, and labral abnormalities were detected in 32 (96.9%), 16 (48.4%), and 9 (27.2%) hips, respectively.

DISCUSSION

In this study, most elderly patients with femoral neck fractures exhibited acetabular cartilage and labral abnormalities, which were already present at the time of surgery. Therefore, surgeons should carefully examine these abnormalities as they may impact postoperative outcomes such as pain and function.

Increased prevalence of femoroacetabular impingement on the elderly with fractures of the proximal femur

Objectives: Femoroacetabular impingement (FAI) has been recently related to several pathologies, besides chondral injury and hip arthritis. We aim to investigate the prevalence of FAI morphology in an elderly cohort hospitalized due to a proximal femur fracture and compare these findings to a control group. We hypothesize that limited medial rotation due to FAI’s morphology could increase stresses to the proximal femur, acting as a facilitating mechanism for fractures in this region. Therefore, a higher prevalence of FAI morphology would be present in the study group. Methods: A retrospective cross-sectional study was performed based on the analysis of radiographic images in AP and lateral views of the fractured hip. Firstly, we have set to measure FAI prevalence in an elderly cohort victimized by fractures of the proximal by measures of the alpha, Tönnis, and lateral center edge angles of a hundred consecutive patients hospitalized for proximal femur fractures. Secondly, we have analyzed the possible relationship between the FAI subtypes and the type of fracture. Finally, we have compared this sample’s data with that of a similar control cohort not affected by fracture. Results: The cohort in this study displayed a higher prevalence of pathological changes in the Tönnis, center-edge, and alpha angles with odds ratios of 3.41, 2.56, and 4.80, respectively (with statistical significance). There was also a significant relationship between cam-type FAI and intertrochanteric fractures, corroborating our initial hypotheses. Conclusions: This study demonstrated that a cohort of older patients affected by fractures of the proximal femur had an increased prevalence of radiographic signs of femoroacetabular impingement. Furthermore, this is the first study demonstrating a statistically significant relationship of cam-type FAI with intertrochanteric fractures, suggesting a possible cause and effect relationship.