A femoral shaft stress fracture is a complete or incomplete break in the long part of the thigh bone (femur) caused by intense exercise or repetitive pressure on the extremity. Stress fractures in the hip and pelvis region (femoral neck, pubis, sacrum, and ischium) are more common in female runners and should not be missed, as a possible differential diagnosis of hip and groin pain. 4, 10, 23, 24 Furthermore, if not treated correctly, femoral shaft stress fractures are well known for complications and difficulties, such as delayed healing, fracture displacement, and symptom recurrence. Stress fracture of shaft of femur, stress fracture of shaft of femur (diagnosis), stress fracture of shaft of femur, Stress fx shaft femur. The wear and injury in the bone exceeds the bone's ability to heal and repair the injury, resulting in a breakdown of the bone, causing a stress or fatigue fracture. Conservative treatment is highly successful in healing these fractures without complications. A femoral stress fracture often starts with a deep, dull gnawing or aching in the groin (inside of the leg) or front of the hip. Femoral stress fractures make up about 6.6% of all lower extremity stress fractures; Stress fractures represent between 0.7% and 20% of all sports medicine injuries. the femoral neck narrowing deformity induced by a femo- ral shaft fracture, which was fixed with an intramedul- lary nail through the piriformis fossa (neither passing Therefore, careful risk and benefit should be balanced while determining the appropriate candidate for using bisphosphonate therapy. Low-impact shaft fractures tend to occur in older patients with pre-existing osteopenia, who have fallen from a standing position.Femoral fractures typically present as a painfully swollen . Femoral neck stress fractures are considered high-risk for complications, particularly displacement; whereas, femoral shaft stress fractures are low-risk. In addition to assessing the healing process, it can also be used to assess the effectiveness of other treatments. Atypical femoral fractures, also known as bisphosphonate-related proximal femoral fractures, are an example of insufficiency fractures, although the direct causative link remains somewhat controversial 2.The atypical fracture pattern occurs in the femur shaft and may be unilateral or bilateral. Femoral Shaft Stress Fractures. The spectrum of femur fractures is wide and ranges from non-displaced femoral stress fractures to fractures associated with severe comminution and significant soft-tissue injury. English. It is estimated that up to 5% of all stress fractures involve the femoral neck . Mid-diaphyseal stress (insufficiency) fractures of the femur caused by osteoporosis are rare. And it becomes stronger or sharper with more strenuous movement . Vague pain in the thigh that radiates into the hip and/or groin region. You should never feel pain unless it is that of muscle soreness/stiffness. Femoral neck stress fractures are considered high-risk for complications, particularly displacement; whereas, femoral shaft stress fractures are low-risk. Vague pain in the thigh that radiates into the hip and/or groin region can indicate a femoral stress fracture. It has been suggested that this predilection may relate to the biomechanical forces exerted on the bone during weight bearing and muscle exertion [ 4 ]. In conclusion, longitudinal stress fractures of the femur shaft remain a rare occurrence, but radiologists and clinicians alike should be aware of this possibility in older patients with new hip or thigh pain. They can, however, also be found in the mid- or distal third. Stress fractures of the femoral shaft are not common but when they do occur it is usually in the proximal third of the femur. It can heal improperly, lead to . Femoral neck stress fractures account for approximately 11% of stress fractures in athletes; the incidence of stress fractures in the femoral shaft has been reported as approximately 3.5%, but is suspected to be as high as 20% in athletes. Stress fracture, right femur, initial encounter for fracture. Do not take any pain relievers while attempting to complete this program, as they may prevent you from safely moving from stage to stage. The femur is a large and strong bone that helps form the hip and knee joints at its proximal and distal ends and has a long shaft that runs down the entire length of the thigh. Hi, I've battled with two femoral stress fractures, and there have been a number of threads on here with some very helpful information. In femoral shaft stress fractures, hip A/PROM not typically limited, but can be painful, however in femoral neck stress fractures, a gross limitation in A/PROM can be present. The spectrum of femur fractures is wide and ranges from non-displaced femoral stress fractures to fractures associated with severe comminution and significant soft-tissue injury. These fractures are often associated with polytrauma and can be life-threatening. Stress fractures of the femoral shaft are uncommon and mostly occur at the proximal third of the femur. M84.351A is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The distribution of the stress fractures by site was: tibia 182, metatarsal bones 73. fibula 44, big toe sesamoid bones 15, femoral shaft 14, femoral neck 9, tarsal navicular 9, pelvis 7 olecranon . These injuries are often not considered in the initial presentation, and a high index of suspicion must be maintained. The wear and injury in the bone exceeds the bone's ability to heal and repair the injury, resulting in a breakdown of the bone, causing a stress or fatigue fracture. Femoral stress fracture, a fracture to the thighbone, is the fourth most common fracture in athletes and military recruits. Sometimes, the pain is felt in the thigh. The 2022 edition of ICD-10-CM M84.351A became effective on October 1, 2021. If the clinical test is positive during the physical examination, the diagnosis is confirmed by a bone scan or a Magnetic Resonance Imaging scan(MRI). Stress fractures may be incomplete or complete, and either non-displaced or displaced. This means that while there is no exact mapping between this ICD10 code M84.353A and a single ICD9 code, 733.97 is an approximate match for comparison and . Red Flags. It is also useful in assessing the healing response. They are more common in the femoral neck, the tibial shaft, the metatarsals, and other bones of the foot. Groin pain with single leg hop (70%) Diagnosis can often be made on radiographs alone but MRI studies should be obtained in patients with normal radiographs with a high degree of suspicion for stress fracture. Stress fractures of the femur can occur in the whole bone like the neck, shaft and the condyles.Femoral stress fractures mainly develop on the medial compression side of the femoral shaft, within the proximal and middle thirds of the bone. Disease or Syndrome ( T047 ) ICD9. She was treated elsewhere with a 9 mm intramedullary Kuntscher nail inserted retrograde. The pain is more noticeable when you walk or put weight on the leg. Stress fracture of the femoral shaft is uncommon and could occur at any sites along the femoral shaft between the subtrochanteric and supracondylar areas and involve later-al femoral cortex at initial presentation. In runners, stress fractures represent 16% of all injuries The most common site for a femoral shaft Fractures elsewhere in the femur or acetabulum, including femoral neck fractures, should be suspected and investigated. Femoral shaft stress fractures cause athletes to complain of mild deep thigh pain with weight-bearing. Background: Stress fractures do not often occur in the shaft of the femur. Atypical femoral fractures have been defined by the American Society for Bone and Mineral Research . Red Flags. Stress fractures of the femur in runners may occur in the femoral neck, trochan-teric and subtrochanteric region, and femoral shaft. This 56-year-old woman fell at work from the loading platform of a truck and broke her left femoral shaft. The diagnosis . Providers should consider a broad differential diagnosis, to include femoral shaft stress fracture, when treating endurance athletes and military recruits with anterior hip, thigh, or knee pain. 225. The fulcrum test is used to aid the diagnosis of femoral shaft stress fractures. Medically reviewed by Dr. Chaminda Goonetilleke, 21st Feb. 2022. Symptoms of a femoral stress fracture A bone scan or an magnetic resonance imaging (MRI) scan is usually used to confirm a diagnosis if the clinical test is positive during the physical examination. Although femoral shaft stress fractures can occur at any site along the bone, the medial aspect of the proximal and middle thirds of the shaft appears to be particularly susceptible. Objectives: To describe the clinical presentation, diagnosis, treatment, and outcome . A stress fracture is a partial or incomplete fracture caused by the accumulation of stress to a localized area of bone. Furthermore, if not treated correctly, these fractures are well known for complications and difficulties. MRI also revealed a cortical thickening and an underlying stress fracture of the medial cortical bone of the femoral shaft, appearing as a hypointense fracture line on both T1- and T2-weighted sequences (Figure 2b), associated with cortical thickening. References. Femur fractures are typically described by location (proximal, shaft, distal). Femoral stress fractures make up about 6.6% of all lower extremity stress fractures; Stress fractures represent between 0.7% and 20% of all sports medicine injuries. They are most commonly associated with vigorous weight-bearing activities, such as running, gymnastics . 733.97. Background. Background. Stress fractures of the femoral shaft in athletes occur most commonly in the proximal third of the femur. Seen most frequently in runners, dancers, and military recruits. Imaging is diagnostic, especially when performing CT and MR. They commonly result from high-energy mechanisms such as motor vehicle collisions (MVC) with sequelae of limb shortening and deformities if not treated appropriately. o No significant difference in femur fracture patterns has been found when proven cases of child abuse are compared to a control group. Fractures of the femoral shaft are one of the most common injuries treated by orthopedic surgeons. The femur helps support the weight of the body and move the leg. A femoral stress fracture is a condition characterized by an incomplete crack in the femur (thigh bone). @article{Lawande2007AdductorIA, title={Adductor insertion avulsion syndrome with stress fracture of femoral shaft: MRI findings. . ral stress fractures are typically treated conservatively, including a period of nonweight bearing and a return to activity between 6 and 14 weeks1,16,17; however, size and location can influence the course of treatment. MRI depicts the changes of stress injury in the femoral diaphysis, and is particularly useful in documenting the presence, morphology, and extent of fracture(s), information valuable for . Patients may also present with the following: Anterior thigh (45.9%), hip (27.0%), and/or groin (8.1%) pain; Groin pain with single leg hop (70%) Hip A/PROM not typically limited, but can be painful (femoral shaft stress fractures) Diagnosis can often be made on radiographs alone but MRI studies should be obtained in patients with normal radiographs with a high degree of suspicion for . The symptoms of these lesions are vague and confusing. Stress Fractures of the Femur can be caused by disease, poor nutrition, osteoporosis and overuse. A femoral shaft stress fracture can be diagnosed using the fulcrum test. 4,7, 9 Although unproven, this high tensile stress is presumably why these fractures are seen in the lateral cortex of the femur. 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