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Femoral Neck Stress Fracture

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81. Stress Fractures (Diagnosis)

decreased activity and immobilization; however, patients with some stress fractures, such as displaced femoral neck stress fractures and fifth metatarsal base stress fractures, are more likely to have complications such as nonunion. [ , ] These complications should be monitored closely because surgical intervention may be necessary. Next: Pathophysiology Stress fractures result from recurrent and repetitive loading of bone. The stress fracture differs from other types of fractures in that in most cases (...) . . Welck MJ, Hayes T, Pastides P, Khan W, Rudge B. Stress fractures of the foot and ankle. Injury . 2017 Aug. 48 (8):1722-1726. . . Joshi A, Kc BR, Shah BC, Chand P, Thapa BB, Kayastha N. Femoral neck stress fractures in military personnel. JNMA J Nepal Med Assoc . 2009 Apr-Jun. 48(174):99-102. . Taimela S, Kujala UM, Orava S. Two consecutive rib stress fractures in a female competitive swimmer. Clin J Sport Med . 1995 Oct. 5(4):254-6; discussion 257. . Lee AD. Golf-related stress fractures

2014 eMedicine Surgery

82. Stress Fracture (Treatment)

of flexibility training and dynamic lumbar spinal stabilization. The program should emphasize pain-free functional progression. Once the athlete can perform sport-specific skills without symptoms, he or she may return to training and competition. Unilateral spondylolysis tends to have a more favorable clinical outcome than bilateral spondylolysis. For a more detailed discussion, see the article . Femoral neck stress fracture Stress fractures of the femoral neck [ , ] can occur either on the superior (...) sufficient for the physician to confirm or exclude the diagnosis. However, MRI, with its sensitivity and high anatomic detail, is being used with increasing frequency. For patients diagnosed with early stress reaction or a nondisplaced stress fracture of the femoral neck, treatment consists of avoidance of weight bearing on the affected lower limb until symptoms resolve. Subsequently, the individual is permitted to resume partial weight bearing as tolerated, progressing over time to unprotected weight

2014 eMedicine.com

83. Stress Fracture (Overview)

injuries description of an under-recognized injury problem among military personnel. Am J Prev Med . 2010 Jan. 38(1 Suppl):S61-70. . Evans JT, Guyver PM, Kassam AM, Hubble MJ. Displaced femoral neck stress fractures in Royal Marine recruits--management and results of operative treatment. J R Nav Med Serv . 2012. 98(2):3-5. . Corrarino JE. Stress fractures in runners. Nurse Pract . 2012 Jun 10. 37(6):18-28. . Briskin SM. Injuries and medical issues in softball. Curr Sports Med Rep . 2012 Sep. 11(5):265 (...) DM, Sawyer JR, Warner WC Jr. Use of magnetic resonance imaging in the evaluation of spondylolysis. J Pediatr Orthop . 2015 Apr-May. 35 (3):271-5. . Arendt E, Agel J, Heikes C, Griffiths H. Stress injuries to bone in college athletes: a retrospective review of experience at a single institution. Am J Sports Med . 2003 Nov-Dec. 31(6):959-68. . Ramey LN, McInnis KC, Palmer WE. Femoral Neck Stress Fracture: Can MRI Grade Help Predict Return-to-Running Time?. Am J Sports Med . 2016 Aug. 44 (8):2122-9

2014 eMedicine.com

84. Stress Fracture (Follow-up)

AM, Hubble MJ. Displaced femoral neck stress fractures in Royal Marine recruits--management and results of operative treatment. J R Nav Med Serv . 2012. 98(2):3-5. . Corrarino JE. Stress fractures in runners. Nurse Pract . 2012 Jun 10. 37(6):18-28. . Briskin SM. Injuries and medical issues in softball. Curr Sports Med Rep . 2012 Sep. 11(5):265-71. . Kahanov L, Eberman LE, Games KE, Wasik M. Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners. Open Access (...) , Heikes C, Griffiths H. Stress injuries to bone in college athletes: a retrospective review of experience at a single institution. Am J Sports Med . 2003 Nov-Dec. 31(6):959-68. . Ramey LN, McInnis KC, Palmer WE. Femoral Neck Stress Fracture: Can MRI Grade Help Predict Return-to-Running Time?. Am J Sports Med . 2016 Aug. 44 (8):2122-9. . Hoffman DF, Adams E, Bianchi S. Ultrasonography of fractures in sports medicine. Br J Sports Med . 2015 Feb. 49 (3):152-60. . Nicola TL, El Shami A. Rehabilitation

2014 eMedicine.com

85. Stress Fracture (Diagnosis)

injuries description of an under-recognized injury problem among military personnel. Am J Prev Med . 2010 Jan. 38(1 Suppl):S61-70. . Evans JT, Guyver PM, Kassam AM, Hubble MJ. Displaced femoral neck stress fractures in Royal Marine recruits--management and results of operative treatment. J R Nav Med Serv . 2012. 98(2):3-5. . Corrarino JE. Stress fractures in runners. Nurse Pract . 2012 Jun 10. 37(6):18-28. . Briskin SM. Injuries and medical issues in softball. Curr Sports Med Rep . 2012 Sep. 11(5):265 (...) DM, Sawyer JR, Warner WC Jr. Use of magnetic resonance imaging in the evaluation of spondylolysis. J Pediatr Orthop . 2015 Apr-May. 35 (3):271-5. . Arendt E, Agel J, Heikes C, Griffiths H. Stress injuries to bone in college athletes: a retrospective review of experience at a single institution. Am J Sports Med . 2003 Nov-Dec. 31(6):959-68. . Ramey LN, McInnis KC, Palmer WE. Femoral Neck Stress Fracture: Can MRI Grade Help Predict Return-to-Running Time?. Am J Sports Med . 2016 Aug. 44 (8):2122-9

2014 eMedicine.com

86. Stress Fractures (Treatment)

Aug. 48 (8):1722-1726. . . Joshi A, Kc BR, Shah BC, Chand P, Thapa BB, Kayastha N. Femoral neck stress fractures in military personnel. JNMA J Nepal Med Assoc . 2009 Apr-Jun. 48(174):99-102. . Taimela S, Kujala UM, Orava S. Two consecutive rib stress fractures in a female competitive swimmer. Clin J Sport Med . 1995 Oct. 5(4):254-6; discussion 257. . Lee AD. Golf-related stress fractures: a structured review of the literature. J Can Chiropr Assoc . 2009 Dec. 53(4):290-9. . Karlson KA. Rib stress (...) Sesamoids 0 0 100 Femur, shaft 7 7 86 Femur, neck 0 0 100 Pelvis 0 29 75 Olecranon 0 0 100 *Adapted from Hulkko. [ ] Findings were from a case series of 368 stress fractures in athletes, in which the healing times of stress fractures in different locations were assessed. Next: Surgical Care Surgery for high-risk stress fractures Nonunion of stress fractures is uncommon but can occur. These injuries should be closely followed up for early surgical intervention. They include stress fractures of the neck

2014 eMedicine Surgery

87. Stress Fractures (Follow-up)

Aug. 48 (8):1722-1726. . . Joshi A, Kc BR, Shah BC, Chand P, Thapa BB, Kayastha N. Femoral neck stress fractures in military personnel. JNMA J Nepal Med Assoc . 2009 Apr-Jun. 48(174):99-102. . Taimela S, Kujala UM, Orava S. Two consecutive rib stress fractures in a female competitive swimmer. Clin J Sport Med . 1995 Oct. 5(4):254-6; discussion 257. . Lee AD. Golf-related stress fractures: a structured review of the literature. J Can Chiropr Assoc . 2009 Dec. 53(4):290-9. . Karlson KA. Rib stress (...) Sesamoids 0 0 100 Femur, shaft 7 7 86 Femur, neck 0 0 100 Pelvis 0 29 75 Olecranon 0 0 100 *Adapted from Hulkko. [ ] Findings were from a case series of 368 stress fractures in athletes, in which the healing times of stress fractures in different locations were assessed. Next: Surgical Care Surgery for high-risk stress fractures Nonunion of stress fractures is uncommon but can occur. These injuries should be closely followed up for early surgical intervention. They include stress fractures of the neck

2014 eMedicine Surgery

88. Hyponatremia in Elderly Patients With Hip Fractures

, and congestive heart failure), polypharmacy (e.g., antihypertensives, antidepressants, and antiepileptics), hospitalization, perioperative fluid restrictions, and homeostatic stress from the fracture itself and the subsequent surgery. The aim of this study is to compare incidence of hyponatremia in elderly patients (>70 years) with hip fractures (case group) to incidence of hyponatremia in elderly patients(>70 years) undergoing joint replacement or prostate surgery(control group). Condition or disease (...) assessment must be made, focusing on fluid status, examining the potential etiology, and conducting the appropriate investigations. In approximately 50% of patients, chronic hyponatremia results from inappropriate antidiuretic hormone secretion. Chronic mild hyponatremia is usually asymptomatic and is traditionally regarded as benign. However, it is associated with a lower bone mineral content and density in nearly all regions of the hip, with more pronounced losses in the trochanteric and femoral neck

2018 Clinical Trials

89. Mechanical simulation study of postoperative displacement of trochanteric fractures using the finite element method (PubMed)

the femoral neck axis (type B). Thereafter, FE models of the femur and a sliding hip screw mounted on a 135° three-hole side-plate were constructed. A 2010-N load was applied to the femoral head, and a 1086-N load was applied to the greater trochanter. Under this condition, the maximum value of the von Mises stress distribution and the amount of displacement of the femoral head vertex in the distal direction were investigated.A larger maximum stress value at the medial femoral neck cortex and a higher (...) Mechanical simulation study of postoperative displacement of trochanteric fractures using the finite element method Femoral trochanteric fractures are common among older adults. In the reduction of trochanteric fractures, acquiring the support of the anterior cortex at the fracture site on lateral view immediately after surgery is important. However, even if the cortical support is acquired, postoperative displacement due to the loss of this support often occurs. This study aimed to investigate

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2018 Journal of orthopaedic surgery and research

90. Biofidelic finite element models for accurately classifying hip fracture in a retrospective clinical study of elderly women from the AGES Reykjavik cohort. (PubMed)

biofidelic models, one with linear elastic and the other with non-linear stress-strain relationships in the proximal femur. The expected end-point value (EEV) was defined as the FR weighted by the probability of one sideways fall over five years, based on self-reported fall frequency at baseline. The change in maximum volumetric strain (ΔMVS) on the surface of the femoral neck was calculated between time of ultimate femur force and 90% post-ultimate force in order to assess the extent of tensile tissue (...) difference in AUC was detected between ΔMVS (0.85), and aBMD (0.74). Multivariable linear regression suggested that the variance in maximum elastic femur force was best explained by femoral head radius, pelvis width, and soft tissue thickness (R2 = 0.79; RMSE = 0.46 kN; p < 0.005). Weighting the hip fracture prediction models based on self-reported fall frequency did not improve the models' sensitivity, however excluding non-fallers lead to significant differences between aBMD and FE based models

2018 Bone

91. Anatomical distribution of the degree of mineralization of bone tissue in human femoral neck: impact on biomechanical properties. (PubMed)

Anatomical distribution of the degree of mineralization of bone tissue in human femoral neck: impact on biomechanical properties. Osteoporotic hip fractures represent a major public health problem associated with high human and economic costs. The anatomical variation of the tissue mineral density (TMD) and of the elastic constants in femoral neck cortical bone specimens is an important determinant of bone fragility. The purpose of this study was to show that a Synchrotron radiation (...) microcomputed tomography system coupled with a multiscale biomechanical model allows the determination of the 3-D anatomical dependence of TMD and of the elastic constants (i.e. the mechanical properties of an anisotropic material) in human femoral neck. Bone specimens from the inferior femoral neck were obtained from 18 patients undergoing standard hemiarthroplasty. The specimens were imaged using 3-D synchrotron micro-computed tomography with a voxel size of 10.13 μm, leading to the determination

2012 Bone

92. Osteoporosis - prevention of fragility fractures

density (BMD) of 2.5 standard deviations below the mean peak mass (average of young healthy adults) as measured by dual-energy X-ray absorptiometry (DXA) applied to the femoral neck and reported as a T-score. However, BMD measurement does not assess the structural deterioration in bone and consequently, most osteoporotic fractures occur in women who do not have osteoporosis as defined by a T-score equal to or less than -2.5. [ ; ] Causes What causes osteoporosis and osteoporotic fractures (...) that measurement of BMD at the lumbar spine, femoral neck, total hip, and wrist have been shown to predict future fracture occurrence [ ]. A lack of evidence to support bone-sparing treatment based solely on high fracture risk (without DXA to confirm the presence of osteoporosis) to reduce fracture risk [ ]. Additional investigations The recommendations on additional investigations to consider are based on the National Institute for Health and Care Excellence (NICE) guideline Osteoporosis: assessing the risk

2016 NICE Clinical Knowledge Summaries

93. Automated DXA-based finite element analysis for hip fracture risk stratification: a cross-sectional study. (PubMed)

fracture and FRIs derived from automated finite element analysis (FEA) of DXA hip scans. Femoral neck, intertrochanteric, and subtrochanteric FRIs were calculated as the von Mises stress induced by a sideways fall divided by the bone yield stress over the specified region of interest (ROI).Using the Manitoba Bone Mineral Density Database, we selected women age ≥ 65 years with femoral neck T-scores below - 1 and no osteoporosis treatment. From this population, we identified 324 older women with hip (...) Automated DXA-based finite element analysis for hip fracture risk stratification: a cross-sectional study. Fracture risk indices (FRIs) generated from DXA-based finite element analysis were associated with hip fracture independent of FRAX score computed with femoral neck bone mineral density (BMD). Prospective studies are warranted to determine whether FRIs represent an improvement over BMD for predicting incident hip fractures.The study aims to examine the association between prior hip

2017 Osteoporosis International

94. Prehospital intravenous fentanyl to patients with hip fracture: an observational cohort study of risk factors for analgesic non-treatment. (PubMed)

to alleviate the stress that follows acute pain, to facilitate transportation, and to improve quality of care. The objectives of this study were to explore the prevalence of prehospital administration of intravenous fentanyl to patients with proximal femoral neck fracture in the ambulances and to assess risk factors for analgesic non-treatment.This was a register-based observational cohort study of patients with proximal femoral neck fracture from the North Denmark Region transported by ambulance (...) Prehospital intravenous fentanyl to patients with hip fracture: an observational cohort study of risk factors for analgesic non-treatment. Patients with proximal femoral neck fracture have a high short-term mortality, a high risk of postoperative complications, and impaired quality of life. One of the challenges related to the prehospital treatment of these patients is to administer systemic opioids fast and properly. Effective analgesic prehospital treatment ought be initiated rapidly in order

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2017 Scandinavian journal of trauma, resuscitation and emergency medicine

95. Impingement between the acetabular cup and the femoral neck after hip resurfacing arthroplasty. (PubMed)

Impingement between the acetabular cup and the femoral neck after hip resurfacing arthroplasty. Loosening, femoral neck fracture, and metal ion release have been well documented after hip resurfacing arthroplasty, but impingement between the acetabular cup and the femoral neck has not. The goal of this study was to analyze radiographic findings that were presumed to represent impingement of the neck after hip resurfacing arthroplasty, and to describe the mechanism of impingement.Of the 635 hips (...) edge of the socket. No significant factors were found to be related to the occurrence of impingement.Femoral-neck impingement should be differentiated from notching, narrowing, stress-shielding, or osteolysis of the femoral neck. Although we found no significant factors to explain the impingement found in the hips in our study, it appears that repetitive extreme motion of the involved hip and malposition of the implants can cause impingement after hip resurfacing arthroplasty.

2011 The Journal of Bone and Joint Surgery. American Volume

96. Determinants of stress fracture risk in United States Military Academy cadets. (PubMed)

of stress fracture was higher in those who exercised <7 h per week during the prior year (RR 2.31; CI 1.29,4.12), and in those with smaller tibial cortical area (RR 1.12; CI 1.03,1.23), lower tibial bone mineral content (RR 1.11; CI 1.03,1.20) and smaller femoral neck diameter (RR 1.35, CI 1.01, 1.81). In women, higher stress fracture risk was seen in those with shorter time since menarche (RR 1.44 per year; CI 1.19, 1.73) and smaller femoral neck diameter (RR 1.16; CI 1.01, 1.33.).Although prior (...) Determinants of stress fracture risk in United States Military Academy cadets. Prior studies have identified some risk factors for stress fracture in athletes and military recruits.To determine whether historical factors, physical measures, biochemical variables of skeletal metabolism, genetic factors, bone density (BMD) and bone size could predict risk of stress fracture over 4 years in physically fit cadets at the US Military Academy (USMA).Baseline surveys, assessments of height, weight

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2013 Bone

97. Isolated Right Ventricular Stress (Takotsubo) Cardiomyopathy (PubMed)

Isolated Right Ventricular Stress (Takotsubo) Cardiomyopathy A 79-year-old woman was admitted with a left femoral neck fracture and she immediately developed circulatory shock. Echocardiography showed a markedly enlarged right ventricle (RV) with systolic ballooning of the mid-ventricular wall and preserved contractility of the apex. The left ventricular (LV) motion was normal. Multi-detector-row computed tomography showed severe congestion of the contrast media in the right atrium (...) with no forward flow to RV, but no pulmonary embolism. She was successfully treated with percutaneous veno-arterial extracorporeal membrane oxygenation. This case presented with acute, profound, but reversible RV dysfunction triggered by acute stress in a manner similar to that seen in LV stress cardiomyopathy.

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2017 Internal Medicine

98. A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: A case report (PubMed)

A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: A case report This report presents a case of a displaced stress fracture of the femoral neck in an adolescent female distance runner with amenorrhea. Both reduction and internal fixation were performed early after the injury. At 24 months postoperatively, magnetic resonance imaging and bone scintigraphy showed no positive signs of femoral head necrosis and bone union was confirmed (...) on plain X-ray. A medical examination for the presence of the signs of the female athlete triad by checking weight, calorie intake and menstrual cycles is most important to prevent such stress fractures. Athletes as well as their coaches or parents therefore need to understand female athlete triad.

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2010 Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology: SMARTT

99. Bisphosphonates: atypical femoral fractures

for: prophylaxis and treatment of osteoporosis treatment of Paget’s disease as part of some cancer regimens, particularly for bone metastases and multiple myeloma In 2008, a Europe-wide review of bisphosphonates and atypical stress fractures concluded that alendronic acid use was associated with an increased risk of atypical stress fractures of the proximal femoral shaft and a warning was subsequently added to alendronic acid product information. At that time, the available data neither supported nor refuted (...) : atypical femoral fractures have been reported rarely with bisphosphonate therapy, mainly in patients receiving long-term treatment for osteoporosis; atypical femoral fractures are considered a class effect of bisphosphonates they can occur after minimal or no trauma - some patients experience thigh or groin pain, often associated with features of stress fractures on radiograph, weeks to months before presenting with a completed femoral fracture; poor healing of these fractures has been reported

2011 MHRA Drug Safety Update

100. Atypical Femur Fractures in Patients Treated with Bisphosphonates: Identification, Management, and Prevention (PubMed)

although lower mortality than the more common osteoporotic neck-of-femur fractures. A case definition has been described to allow identification of this class of fracture. Further work has established a high relative risk of AFFs in patients treated with bisphosphonates, but a low absolute risk in comparison to that of osteoporotic fractures. Proposed pathological mechanisms include low bone turnover states leading to stress/insufficiency fractures. Clinicians should be aware of the risk of AFFs (...) Atypical Femur Fractures in Patients Treated with Bisphosphonates: Identification, Management, and Prevention Osteoporosis is a common condition with significant health care costs. First-line therapy is with bisphosphonates, which have proven anti-fracture efficacy. Around 10 years after the introduction of bisphosphonates reports began to be published of atypical femoral fractures (AFFs) that may be associated with this therapy. These fractures are associated with significant morbidity

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2016 Rambam Maimonides medical journal

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