Bilateral femoral neck stress fractures

Case contributed by Matt Skalski
Diagnosis certain

Presentation

Soccer player with bilateral hip pain which is becoming increasingly severe on the left.

Patient Data

Age: 55 years
Gender: Male
AP
pelvis
AP
spot
Frog
leg
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Info

Bilaterally there is increased cortical thickness of the medial femoral necks with a linear area of central lucency, worse on the left. The left femoral neck also demonstrates cortical irregularity which is most offset at the intersection with the lucent line. 

This study is a stack
Axial bone
window
This study is a stack
Coronal
bone window
This study is a stack
Sagittal
bone window
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Info

Thickening of the medial cortex of the femoral necks bilaterally which contain a linear central lucency, worse on the left.

This study is a stack
Coronal
T1
This study is a stack
Coronal
STIR
This study is a stack
Coronal PD
fat sat
This study is a stack
Axial PD
fat sat
This study is a stack
Sagittal
PD fat sat
This study is a stack
Axial
T1
This study is a stack
Axial T2
fat sat
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Info

Bilaterally there are low T1/STIR-weighted signal lines within the medial portions of the femoral necks, with surrounding hyperintense STIR signal within the left femoral neck. There is associated mild surrounding soft-tissue edema on the left as well, but no evidence of retracted tendon tear. 

Bilaterally there is circumferential moderate osteophyte formation of the acetabuli and femoral head-neck junctions with complex multifocal degenerative masseration of the right and left labrum. 

Case Discussion

Non-displaced acute stress fracture of the left femoral neck, and chronic stress fracture of the right femoral neck.

Remember that stress fractures are caused by abnormal stress on normal bone, whereas insufficiency fractures are due to normal stress on the abnormal bone. 

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