Femoral neck stress fractures and femoroacetabular impingement: A retrospective case study and literature review

Background: Femoroacetabular impingement (FAI) can lead to morphologic damage of both the acetabulum and the femoral neck. Recent reports have found an association between impingement deformities and the development of femoral neck stress fractures. The aim of this study was to report a series of patients with these findings and to update the current evidence on the topic. Material and methods: 5 patients (6 cases) with atraumatic femoral neck fractures and FAI were identified in the Dresden hip registry from 2015 to 2018. Demographic data, comorbidities, radiographic results and bone metabolism results were described. A literature search was conducted using keywords related to femoral neck stress fractures and FAI syndrome. Results: The average age of the series was 39 (range: 22–52), 2 patients were female and 3 male. A total of 12 surgical procedures were performed. 4 of the 5 patients showed radiographic features of pincer and/or cam-FAI, whereas 3 patients had a decreased femoral antetorsion (−7° to +7° antetorsion). In 3 patients, magnetic resonance imaging revealed additional signs of avascular necrosis ARCO I. There was a lack of FAI-specific treatment recommendations in the available literature. Discussion: Radiographic results of the patients evaluated suggested that impingement-associated deformities of the hip may cause femoral neck stress fractures, which is in line with the available literature. This potential coincidence should be integrated in diagnostic algorithms and therapeutic approaches.