Management of Pediatric Femoral Neck Fracture

Joseph T. Patterson, MD; Jennifer Tangtiphaiboontana, MD; Nirav K. Pandya, MD


J Am Acad Orthop Surg. 2018;26(12):411-419. 

In This Article

Management of Atraumatic and Insufficiency Factors

Femoral neck stress fractures are becoming more common because of increased participation in sports and repetitive running and jumping. Stress fractures are thought to result from repetitive, unaccustomed stress that is below the threshold of energy required to cause a complete acute fracture but is sufficient to interfere with the body's normal bone remodeling mechanism. Several authors have proposed classification systems based on the location of the stress fracture and/or radiographic findings.[31,32] Pediatric femoral neck stress fractures commonly occur on the inferior, compression side of the femoral neck; however, tension-sided stress fractures have also been described.[33] In the absence of a traumatic event or an increase in repetitive physical activity level, a pediatric femoral neck stress fracture warrants a thorough endocrine and metabolic workup, including a complete blood count, electrolyte panel, liver function tests, thyroid hormone, 25-vitamin D level, erythrocyte sedimentation rate, and C-reactive protein level.

Although management of femoral stress fractures in adults and athletes has been well described, management of pediatric femoral neck stress fractures has been limited to case reports and series. Initial management of these stress fractures includes a period of activity modification and weight-bearing restrictions. Boyle et al[34] reported on six otherwise healthy patients (average age, 7.7 years) with idiopathic, compression-type femoral neck stress fractures. Four patients healed after 6 to 8 weeks of non-weight bearing restriction followed by 4 to 6 weeks of partial weight bearing. To achieve complete healing, two patients required additional immobilization in a hip spica cast because of poor compliance with weight-bearing restrictions. Although nonsurgical treatment can lead to successful healing, patients with tension-sided stress fractures or those who do not heal with prolonged nonsurgical treatment may require surgical fixation with cannulated screws.[33] Identification of the risk factors for tension-sided stress fractures of the femoral neck is crucial for selection of appropriate intervention.