Article: Proximal Femoral Stress Reaction in A Military Recruit - A Treatment Prospect

Introduction: Stress fractures occur in individuals in whom repetitive strenuous muscle and tendon force act on bone; that have not adapted to such forces. Under a constant load, osteoclast resorption and osteoblastic reconstruction of bone are in equilibrium, resulting in normal remodeling. If loading increases, additional bone resorption occurs. Increased osteoclastic activity at sites of stress may cause local weakening and predispose to micro damage. If allowed to progress, such micro fractures may progress to complete fractures.

Case Report: A 30-year-old man presented with right thigh pain for 3 days without any history of significant trauma. He was a military recruit with history of running 5 miles a day for last 12 years and was running 20 miles a day for last 5 days before he developed pain. Examination revealed pain to palpation along the proximal medial and lateral right thigh. Range of motion was painful and limited. Radiograph of right hip showed fracture line in intertrochanteric region of femur.

Conclusion: Here we have reported a case of stress fracture of proximal femur in intertrochanteric region which to our knowledge has not been reported in the literature so far. This fracture is important to recognize early as there are high chances of displacement resulting in increased risk of complications. We suggest immediate anatomical reduction and stable internal fixation to prevent complications and early mobilization to decrease the morbidity.

Citing Articles

Calvarial melorheostosis: an extremely rare case and diagnostic challenge.

Wenokor G, Suster D, de Leon A, Liu J, Wenokor C, Nimchinsky E Skeletal Radiol. 2025; .

PMID: 39945784 DOI: 10.1007/s00256-025-04882-w.

References

1.

Li G, Zhang S, Chen G, Chen H, Wang A . Radiographic and histologic analyses of stress fracture in rabbit tibias. Am J Sports Med. 1985; 13(5):285-94. DOI: 10.1177/036354658501300501. View

2.

Egol K, Koval K, Kummer F, Frankel V . Stress fractures of the femoral neck. Clin Orthop Relat Res. 1998; (348):72-8. View

3.

Fullerton Jr L . Femoral neck stress fractures. Sports Med. 1990; 9(3):192-7. DOI: 10.2165/00007256-199009030-00006. View

4.

Burr D, Milgrom C, Boyd R, Higgins W, ROBIN G, Radin E . Experimental stress fractures of the tibia. Biological and mechanical aetiology in rabbits. J Bone Joint Surg Br. 1990; 72(3):370-5. DOI: 10.1302/0301-620X.72B3.2341429. View

5.

Johansson C, Ekenman I, Tornkvist H, Eriksson E . Stress fractures of the femoral neck in athletes. The consequence of a delay in diagnosis. Am J Sports Med. 1990; 18(5):524-8. DOI: 10.1177/036354659001800514. View

6.

Fullerton Jr L, Snowdy H . Femoral neck stress fractures. Am J Sports Med. 1988; 16(4):365-77. DOI: 10.1177/036354658801600411. View

7.

DeFranco M, Recht M, Schils J, Parker R . Stress fractures of the femur in athletes. Clin Sports Med. 2005; 25(1):89-103, ix. DOI: 10.1016/j.csm.2005.08.003. View

8.

Knapp T, Garrett Jr W . Stress fractures: general concepts. Clin Sports Med. 1997; 16(2):339-56. DOI: 10.1016/s0278-5919(05)70026-0. View

9.

EVANS F, Riolo M . Relations between the fatigue life and histology of adult human cortical bone. J Bone Joint Surg Am. 1970; 52(8):1579-86. View

10.

Teitz C, Harrington R . Patellar stress fracture. Am J Sports Med. 1992; 20(6):761-5. DOI: 10.1177/036354659202000621. View

11.

Kiuru M, Pihlajamaki H, Ahovuo J . Bone stress injuries. Acta Radiol. 2004; 45(3):317-26. DOI: 10.1080/02841850410004724. View

12.

Mason R, Moore T, Walker C, Kathol M . Patellar fatigue fractures. Skeletal Radiol. 1996; 25(4):329-32. DOI: 10.1007/s002560050090. View

13.

Pentecost R, Murray R, Brindley H . FATIGUE, INSUFFICIENCY, AND PATHOLOGIC FRACTURES. JAMA. 1964; 187:1001-4. DOI: 10.1001/jama.1964.03060260029006. View