Stress Fractures of the Femur

Of all stress fractures, those involving the femur are the fourth most common. They are typically seen in athletes and military recruits who are involved in repetitive loading activities. Femoral stress fractures may occur anywhere along the length of the femur, most commonly at the femoral neck. There are several predisposing factors and medical conditions that may contribute to the development of femoral stress fractures including osteoporosis, the female athlete triad, and possibly certain medications. As with most stress fractures, those involving the femur are frequently associated with overtraining and improper conditioning. Diagnosing femoral stress fractures can prove difficult as athletes often present with vague symptoms that can be attributed to other injuries or conditions. Frequently, advanced imaging is required to help support the diagnosis. While most femoral stress fractures can be managed conservatively with excellent outcomes, in some cases, especially with displaced fractures or high-risk femoral neck stress fractures, operative intervention is recommended. Once athletes have had a period of relative rest, radiographic evidence of healing, and they are able to walk and perform activities of daily living without pain, a gradual return to activities may begin.