Femoral Neck Stress Fracture in Marathon Runners: A Case Report
Yusuwan K, MD1, Chareancholvanich K, MD2
Affiliation : 1 Department of Orthopaedic Surgery, Chaophraya Yommarat Hospital, Suphanburi, Thailand 2 Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Femoral neck stress fracture (FNSF) accounts for 3% of all sports-related stress fractures. The most common cause
is marathon running. The main types of FNSF are compression-sided, tension-sided, and displaced fracture. The most common
symptom is groin pain. Plain radiograph is the first-line investigation, and the magnetic resonance imaging (MRI) is the second-line
investigation. The location and displacement of the fracture guide the management. Early detection and diagnosis decrease the rate
of fracture displacement and osteonecrosis of the femoral head.
Objective : To report two cases of FNSF that developed in two Thai marathon runners, and to review what is currently known about
FNSF in this specific sports-related setting.
Materials and Methods : Two cases of FNSF are described, and a review of the literature relative to FNSFs in long-distance runners
describes the role of imaging, management, and return to running.
Results : FNSFs are a rare injury, and marathon runners presenting with exercise-related groin pain should be evaluated. Management
is based on fracture location and whether or not the fracture is displaced. The first case profiles a patient with delayed FNSF diagnosis.
Fracture displacement was found two weeks after symptom onset, and total hip arthroplasty was performed. The second case
describes a patient with early FNSF diagnosis that was treated conservatively with good outcome.
Conclusion : Although FNSF is a rare injury, it should be considered in marathon runners who present with exercise-related groin
pain. Delayed diagnosis can adversely affect quality of life. Early detection and management of FNSF shows excellent results in terms
of return-to-sport rates.
Keywords : Femoral neck stress fractures, Sport-related injuries, Stress fracture, Marathon runners, Long-distance running
