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. 2017 Mar 15;1(2):E58–E68. doi: 10.1055/s-0043-103946

Table 4 Summary table.

Key Findings
Epidemiology
  • FNSFs comprise 3% of all sport-related stress fractures.

  • Long-distance running and marathon running are the main causative sports.

  • Female gender and low baseline physical fitness are the main risk factors.

Pathophysiology
  • Compression FNSFs develop as a result of fatigue loading of the femoral neck.

  • Tensions FNSFs develop in conjunction with weakening of the hip abductor muscles.

Biomechanics
  • Compression FNSFs form an oblique fracture line with a stable fracture pattern.

  • Tension FNSFs form a vertical fracture line with an unstable fracture pattern.

Presentation
  • The most common reported symptom is exercise-related anterior groin pain.

Examination
  • The most common exam finding is pain at the extremes of hip range of motion

Investigation
  • Plain radiographs form the first-line imaging investigation for FNSFs.

  • MRI scan is now the gold-standard second-line imaging investigation for FNSFs.

Management
  • Incomplete (<50% FNW) compression FNSFs are managed conservatively.

  • Complete compression and incomplete tension FNSFs are managed surgically.

  • Displaced FNSFs require urgent reduction and surgical fixation.

  • The choice of surgical fixation is guided by the fracture pattern.

Sport Outcome
  • Incomplete compression FNSFs demonstrate good sporting outcomes, with reported return rates of 100% and return times of 14 weeks.

  • Displaced FNSFs demonstrate less favourable sporting outcomes, with reported return rates ranging 33–100% and return times ranging from 3 to 12 months.

  • Fracture displacement and high-performance running status have been found to negatively influence return to sport.

Injury Prevention
  • Education programmes and treatment algorithms can reduce rates of displaced FNSFs.

  • Regulated exercise programmes are recommended for endurance runners.

FNW – Femoral Neck Width