Moo Ing How, Lee Y H D, Lim K K, Mehta K V
Department of Orthopaedics Surgery, Changi General Hospital, Singapore, Singapore.
J R Army Med Corps. 2016 Oct;162(5):387-390. doi: 10.1136/jramc-2014-000401. Epub 2015 Jun 17.
Femoral neck stress fractures are rare and can be easily missed and failure to diagnose these injuries early can lead to avascular necrosis, malunion and osteoarthritis. It is important to have a high index of suspicion for femoral neck stress fractures in military recruits. We present three cases of bilateral femoral neck fractures in military recruits, all presenting with unilateral hip symptoms and signs. All the asymptomatic contralateral hips had femoral neck stress fractures diagnosed by screening MRI. Tension type and displaced femoral neck fractures were treated surgically. All the fractures managed healing without complications. Military recruits with unilateral groin pain should have an early referral for MRI hip to rule out femoral neck stress fractures and those military personnel with ipsilateral femoral neck fracture should have MRI of the contralateral hip. Two of the patients had vitamin D deficiency, of which one had elevated parathyroid hormones and low bone mineral density. Our case series highlights the significance of vitamin D deficiency among military recruits.
股骨颈应力性骨折较为罕见，容易被漏诊，而未能早期诊断这些损伤可能会导致缺血性坏死、畸形愈合和骨关节炎。对新兵的股骨颈应力性骨折保持高度怀疑指数很重要。我们报告了3例新兵双侧股骨颈骨折病例，所有病例均表现为单侧髋部症状和体征。所有无症状的对侧髋部经筛查MRI诊断为股骨颈应力性骨折。张力型和移位的股骨颈骨折接受了手术治疗。所有骨折均愈合良好，无并发症。单侧腹股沟疼痛的新兵应尽早转诊进行髋关节MRI检查以排除股骨颈应力性骨折，而同侧股骨颈骨折的军人应进行对侧髋关节MRI检查。其中2例患者存在维生素D缺乏，其中1例甲状旁腺激素升高且骨密度低。我们的病例系列强调了新兵中维生素D缺乏的重要性。
