Hip iSAWE 20

Question

A 24 year old female military recruit has activity related groin pain that has worsened over three weeks of training.

Hip iSAWE 20, AP radiograph of the hip
AP radiograph of the hip. Image by Ruiz Santiago F, Santiago Chinchilla A, Ansari A, Guzmán Álvarez L, Castellano García MM, Martínez Martínez A, Tercedor Sánchez J, Wikimedia Commons, CC BY 4.0.
  1. Describe the radiograph and the next investigation.
  2. How do you classify these fractures?
  3. Outline management and risk factors to address.

Answer

Radiograph

  • Sclerosis on the inferomedial (compression side) femoral neck
  • Femoral neck stress fracture
  • Radiographs are often normal early
  • MRI is the investigation of choice

Classification

TypeManagement
Compression side, under 50% of neck widthProtected weight bearing
Compression side, over 50% or progressionFixation
Tension side (superolateral)Fixation, high risk of displacement
DisplacedUrgent reduction and fixation

Management

  • Non weight bearing with crutches for compression fractures
  • Repeat imaging to confirm healing
  • Cannulated screws for tension side fractures
  • Displaced fractures in young adults need urgent anatomical reduction and fixation
  • AVN and nonunion are common after displacement

Risk factors

  • Relative energy deficiency in sport, the female athlete triad
  • Vitamin D deficiency
  • Sudden training increase
  • Coxa vara

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.