Presentation
An athlete presents with right hip pain. X-rays were normal.
Patient Data
Single phase lower body bone scan with spot images of the hips/pelvis demonstrates abnormal intense radiotracer uptake in the base of the right femoral neck, compressive side, in the region of the lesser trochanter. This finding is characteristic of a femoral neck stress fracture in the appropriate clinical setting.
Additional lesser intense abnormal uptake is present in the left femoral neck and left proximal tibia-fibula joint representing additional bone stress injuries.
Frontal and frog-leg views of the right hip are normal.
Coronal T1 and T2 fat sat images of the pelvis demonstrates abnormal marrow edema (T1 dark, T2 bright) in the base of the right femoral neck, compressive side. There is an underlying transverse fracture line (T1 and T2 dark) originating from the compressive side cortex and extending approximately one-third of the way across the femoral neck.
Case Discussion
Radiotracer uptake in the femoral neck due to a stress fracture can have 2 patterns:
Focal uptake along the inferior aspect of the femoral neck towards the lesser trochanter is associated with a compression type stress fracture (as in this case). This type is seen most commonly in young adults and is low risk, allowing for conservative treatment
Focal uptake along the upper portion of the femoral neck towards the greater trochanter is indicative of a tensile type stress fracture; more often seen in older individuals. A tensile femoral neck stress fracture is prone to progress to a displaced femoral neck fracture with risk of avascular necrosis, and hence may require operative stabilization.
Findings in this case were confirmed on MRI which showed abnormal STIR and T1 signal intensity and a dark fracture line partially traversing the femoral neck.
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