Stress fractures of the femoral neck in adults: an observational study on epidemiology, treatment, and reoperations from the Swedish Fracture Register

Authors

  • Jonas Sundkvist Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University
  • Michael Möller Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg
  • Cecilia Rogmark Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö https://orcid.org/0000-0002-6556-4320
  • Olof Wolf Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden https://orcid.org/0000-0001-6668-8715
  • Sebastian Mukka Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University https://orcid.org/0000-0002-5469-2730

DOI:

https://doi.org/10.2340/17453674.2022.2460

Keywords:

Arthroplasty, Femoral Neck Fracture, Fractures, Hip, Stress fracture

Abstract

Background and purpose: Stress fractures of the femoral neck (sFNFs) are uncommon injuries. Studies on sFNFs are rare. We describe the demographics, classification, treatment, reoperation rates, and mortality in a cohort of sFNF patients from the Swedish Fracture Register (SFR).

Patients and methods: We included 146 patients ≥ 18 years of age with an sFNF registered in the SFR between 2011 and 2020. The cohort was linked with the Swedish Arthroplasty Register and reviewed using medical records and radiographs. We assessed the presence of disorders of bone remodeling, duration of symptoms, fracture classification, treatment, reoperations, and mortality.

Results: The mean age was 58 years (21–96), 75% were women and the median duration of symptoms was 23 days (1–266). 40% of patients had disorders of bone remodeling. 54% were undisplaced (uFNF), 30% displaced (dFNF), and 16% basicervical (bFNF). 14% of patients < 60 years were treated nonoperatively, by internal fixation (IF) in 77% and by arthroplasty in 10%. Patients ≥ 60 years were
treated nonoperatively in 10%, IF in 40%, and arthroplasty in 49%. Nonoperative treatment was reserved for uFNFs or bFNFs, resulting in 35% receiving late surgery. The overall secondary or late surgery rate was 19%. Mortality was 2% at 90 days and increased to 3% at 1 year.

Interpretation: sFNF has a biphasic age distribution. One-third of patients presented with a displaced FNF and those managed nonoperatively for an undisplaced sFNF were at risk of late surgery. The mortality rates for patients with these injuries was low.

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Published

2022-04-08

How to Cite

Sundkvist, J., Möller, M., Rogmark, C., Wolf, O., & Mukka, S. (2022). Stress fractures of the femoral neck in adults: an observational study on epidemiology, treatment, and reoperations from the Swedish Fracture Register. Acta Orthopaedica, 93, 413 – 416. https://doi.org/10.2340/17453674.2022.2460

Issue

Section

National/international register study