​Femoral stress fracture

​​​​​​​​​​​Femoral stress fracture, a fracture to the thighbone, is the fourth most common fracture in athletes and military recruits. Such fractures may be one of two types: an insufficiency fracture or a fatigue fracture.​​

Insufficiency fractures are the byproduct of insufficient bone structure resulting from disease, poor nutrition or osteoporosis. Fatigue fractures result from overusing or overworking the bone. In many cases, the two types of fractures are related. One can lead to the other, particularly with overuse combined with poor nutrition. The highest incidence of femoral stress fracture occurs at the femoral neck where the top of the thighbone joins the hip and pelvis.

Deep thigh or groin pain, particularly while doing activity, is the most common and noticeable symptom of femoral stress fracture. Runners are at highest risk for the injury, followed by gymnasts, ice skaters and ballerinas. Other risk factors include:

• A sudden increase in training (mileage, intensity, frequency)
• A change in running terrain or surface that changes the body mechanics and places different strain on a different part of the body, such as going from trail running to road running
• Biomechanical deficiencies or abnormalities such as a difference between leg lengths or a walking or gait abnormality
• Nutritional deficiencies such as too few calories to compensate for the energy burned during the activity

Diagnosing femoral stress fracture early can be crucial in your return to play and in your overall health. If you have deep thigh and groin pain that has come on gradually and is worsening, you should be screened for fractures. The fulcrum test and a one legged hop can be very helpful in determining the injury.

The fulcrum test is done by placing the examiners forearm under the affected thigh, and pushing down on the knee or thigh with the forearm acting as a fulcrum. If the pain felt during activity is reproduced during this test, further exam and imaging is needed. Magnetic resonance imaging can be helpful in diagnosing the injury and may provide insight as to its specific cause.

Treatment is dependent on the severity of the fracture as determined by your doctor. More severe fractures usually require non-weight bearing status and may require surgery. Less severe fractures may allow for weight bearing depending on comfort and require rest and correction of underlying problems with body mechanics or maintaining adequate nutrition.

Screening of at-risk athletes and education about proper nutrition can help prevent femoral stress fracture. Additionally, focusing on developing strong core muscles and healthful eating can help you achieve optimal performance and ultimately reduce injuries.

Article submitted by Family Medicine Physician Cristin Newkirk, M.D., Marshfield Clinic Wausau Center.​