This protocol addresses a high-risk stress fracture presentation: bone stress injury at the superior cortex of the femoral neck where the fracture line spans more than half the width of the femoral neck. This anatomical site and fracture extent place it among the highest-risk bone stress injury locations, requiring a specific and prompt management pathway.
The superior cortex of the femoral neck is a recognised high-risk location for bone stress injury. When imaging demonstrates a fracture line exceeding 50% of the femoral neck width at this site, conservative management alone is not appropriate. Panel consensus identifies this location and extent as an indication for a definitive intervention.
Management of this presentation involves surgical intervention at the femoral neck. The full protocol specifies the approach, timing, and post-operative pathway — access it via the link below.
Successful management aims for the patient to be pain-free during daily and sports activities, pain-free on palpation of the injury site where accessible, and to demonstrate negative bone loading tests — including the single-leg hopping test — with no pain at the injury site on running.
DOI: 10.1136/bjsports-2024-108616
Bone stress injuries at the femoral neck should be managed surgically if the fracture line is of >50% width of the femoral neck.
Panel consensus on high-risk locations was achieved for the superior cortex of the femoral neck, anterior cortex of tibial diaphysis, navicular and base of fifth metatarsal.
Being pain-free during daily or sports activities. Being pain-free during palpation of injury site (if palpation possible). Negative bone loading tests (eg, single-leg hopping test). Pain with running at the injury site is not permissible when rehabilitating bone stress injuries.
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