Femoral Neck Bone Stress Injuries in Pediatrics and Adolescents: Diagnosis, Etiology, and Treatment Current Concept Review

Abstract

Femoral neck bone stress injuries (FNBSI) are an uncommon diagnosis of groin or hip pain in the adolescent athlete. The true incidence is currently unknown and needs to be considered in the young athlete with atraumatic hip or groin pain. The current literature is sparse in describing the workup and treatment of FNBSI in the adolescent and pediatric population, and the literature lacks consensus of FNBSI nomenclature and appropriate use of imaging for all ages. This leads to inconsistency in understanding the etiology of the injury, prevalence of injury, workup of risk factors for FNBSI, and communication of diagnosis and management. The purpose of this Current Concept Review is to explore the pathophysiology, risk factors and clinical presentation for pediatric and adolescent femoral neck bone stress injuries, discuss existing classification of atraumatic FNBSI, and review imaging tools available to clinicians caring for young athletes. FNBSI occurs as young as age 5 and incidence increases during adolescence. Females are more at risk than males, as are certain sports. Initial imaging of choice is x-rays of the pelvis, followed by an MRI if there is suspicion for a FNBSI. Compression sided FNBSI less than 50% femoral neck width have a high success rate in non-operative treatment, while surgical fixation should be considered for tension sided injury, compression injury >50% femoral neck width, or for those who fail conservative management.