Definition
- Fatigue fracture of the femoral neck from repetitive loading of normal bone
- Insufficiency fractures occur in osteoporotic bone under normal loads
Epidemiology
- Fatigue fractures occur mostly in young endurance athletes and military recruits
- Insufficiency fractures occur in elderly women
- Female athlete triad increases risk
Classification
Fullerton and Snowdy
| Type | Description |
|---|---|
| Tension | Along the superior neck |
| Compression | Along the inferomedial neck |
| Displaced |
Original publication Fullerton Lr Jr, Snowdy HA. Femoral neck stress fractures. Am J Sports Med. 1988;16(4):365-77.
Clinical Features
- Groin or anterior thigh pain with activity, often after training increase
- Pain at extremes of hip rotation and with hopping
- Delayed diagnosis is common
Investigations
- Plain radiographs often normal early
- MRI is the investigation of choice for early detection
- Bone scan if MRI is unavailable
- Screen for low vitamin D, eating disorder and amenorrhoea in athletes
Management
Tension type
- Prone to displacement
- Prompt internal fixation with cannulated screws
Compression type
- Protected weightbearing and activity modification
- Close clinical and radiological follow up
- Fixation if the fracture line progresses, symptoms persist or the fracture widens
- Fixation for compression fractures involving over 50% of neck width
Displaced
- Surgical emergency in the young
- Urgent anatomic reduction and fixation
Complications
- Displacement
- Avascular necrosis, high after displacement
- Nonunion and varus malunion
- End of athletic career after displaced fractures
Prognosis
- Undisplaced fractures diagnosed early heal well
- Displaced fractures in young patients have poor outcomes
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.