Stress fractures of the neck of the femur.

INTRODUCTION THE FIRST recorded case of stress fracture of the femoral neck was described by Blecker in 1905. Since then, many isolated cases have been reported, but it was only in the past decade that any large series emerged. In 1962 Jeffrey described eight patients with spontaneous fractures of the neck of the femur, and pointed out that two distinct varieties of the condition occur. Fatigue or stress fractures occur in young active adults after strenuous and prolonged exercise, in addition to spontaneous fractures in elderly patients without a history of strenuous physical activity. It was with this second variety that his paper was concerned. Four of his eight cases had previously been subjected to radiotherapy for pelvic neoplasms and have been rejected by some authors as true stress fractures. Ernst (1964) reported thirteen cases in young military recruits in training and he drew attention to the difficulty of pinning the fractures and the slowness of the lesions to heal. Devas (1965) reviewed fifty-one cases from the literature and added thirty-two fractures occurring in twenty-five patients. Half of the patients were over sixty-five years of age and the fractures were often associated with osteoporosis, rheumatoid-arthritis or steroid therapy. Blickenstaff and Morris (1966) reported a series of forty-one femoral neck fractures occurring in thirty-six young men during the first eight weeks of basic military training.