Displaced stress fractures of the femoral neck in young male adults: a report of twelve operative cases.

The results of 12 operatively treated displaced stress fractures of the femoral neck in young male adults are reported. The mean age of the patients was 19.8 years (range, 19-24 years) and the mean followup period 4.0 years (range, 1-9 years). Sliding hip compression screw was used in ten cases, Jewett nail in one and 130 degrees angled A0-plate in one case. Aseptic necrosis (AN) of the femoral head developed in five cases treated by sliding hip compression screw. It was correlated with increased operative trauma in four patients: open reduction in two, reoperation in one, and osteotomy in one case. Nonunion developed in three cases and it was combined with AN in two cases. In six cases the results were acceptable, but for the last three patients the followup period was only 1-2 years.

Computed tomography of stress fractures.

Twelve patients with stress fracture were examined by computed tomography (CT). Computed tomography appeared less sensitive than conventional radiographs in visualizing the cortical and periosteal changes. However, CT revealed endosteal callus formation of varying degrees even in cases with minor plain film findings. Two types of endosteal reaction were observed: a general endosteal thickening and a slight local bridge-formed callus. Density of the bone marrow cavity was increased in 10 cases. Soft tissue edema around the lesion was also seen, especially when the tibia was involved. The etiology of these findings is discussed, together with the differential diagnosis of malignant bone or soft tissue tumors.

[A bursa of the tendon of the flexor hallucis longus (author's transl)]. / Bursa tendinis musculi flexoris hallucis longi.

The author reports six cases in whom there was contrast filling of a bursa related to the tendon of the flexor hallucis longus during the course of an arthrogram. All patients had had joint symptoms for a prolonged period; in three patients there was osteochondritis dissecans. Possible mechanism for the development of the bursa is discussed. The hypothesis is proposed that the bursa results from increased pressure in the joint due to recurrent synovitis.

[Stress fractures of the femora in soldiers (author's transl)]. / Stressfrakturen des Femurs bei Soldaten.

Amongst 936 stress fractures found in soldiers, there were 58 in the femora (6%); of these 31 were in the neck and 27 in the shaft. Two were bilateral, and two patients had other stress fractures. Three displacements were found in the necks. In the shaft, 20 fractures were proximal, four were in the middle third and three in the distal third. In the latter group, it is necessary to differentiate from a sarcoma. CT is a new aid in this respect. Sport in highly motivated individuals appears to contribute particularly to fractures of the shaft. The symptoms from these fractures are relatively mild.

Less common stress fractures in the foot.

In a series of 827 stress fractures in soldiers, 15 were found in the first metatarsal, representing 11% of all stress fractures in the metatarsals. All were in the proximal end of the bone. Eight fractures were found in the fourth and four in the fifth metatarsal. In the cuneiform bones three fractures were found, and one in the talus. One fracture was revealed in the lateral sesamoid of the hallux and one in the peroneal bone. Ten patients had stress fractures in other bones too. The radiological appearance and the corresponding stress mechanisms are discussed.

Stress fracture of the pubic arch in military recruits.

An analysis of 49 pubic arch stress fractures in 39 military recruits is presented. These represent eight per cent of all stress fractures and are more common than the fracture in the femoral neck. Every fifth was bilateral and eight patients had stress fractures in other bones. No common aetiology was found. Two-thirds of the fractures occur during the cold season, but skiing was not an important factor. The average time from the first clinical examination to diagnosis was 30 days. An adequate and early radiological examination is important for diagnosis.

Stress fracture in soldiers: a multifocal bone disorder. A comparative radiological and scintigraphic study.

Forty-two military recruits with suspected stress fractures were evaluated by radiographs and radionuclide images. In 3 cases, both studies were negative. The initial radiograph was negative in 13 patients and positive in 29. Many foci shown by the radionuclide image were negative on the radiograph, particularly in the tarsal region. Thus stress fractures are often multifocal and may remain radiographically negative.