Abstract
Femoral neck stress fractures (FNSF) are uncommon, representing 3.5% to 8% of all stress fractures in military recruits. The majority of displaced FNSF undergo operative fixation and are at risk of avascular necrosis (AVN) and non union with a 40–100% medical discharge rate. We aimed to review the incidence and outcome of displaced FNSF in Royal Marine Recruits.
Retrospective review identified 6 Royal Marine recruits, aged 17 to 25, who had suffered a displaced FNSF over a 6 and a half year period. Incidence was 0.93 per 1000 recruits.
Patients were treated urgently by operative fixation with a 2 hole dynamic hip screw device, in 3 cases supplemented with an anti-rotation screw. There were no cases of AVN, no surgical complications and no further procedures were required. All united with a mean time to union of 11 months. 50% had a union time greater than 1 year. 2 completed training, 2 are still in rehabilitation and 2 (33%) were discharged before completion of training.
These fractures are slow to unite compared to other fractures at this site or stress fractures elsewhere. With urgent surgical intervention and stable fixation all however went onto successful union with time and all returned to rehabilitation or training with minimal complications. Awareness of the length of time to union has been invaluable in guiding treatment and rehabilitation. It can help avoid the risks of unnecessary secondary interventions for delay to union.
