Article

Prior literature has suggested an association between the radiographic signs of femoroacetabular impingement (FAI) and femoral neck stress
fractures (FNSF) or femoral neck stress reactions (FNSR). At the time of the
writing of this article, no study has described the association of FAI and
FNSF/FNSR along with the need for surgical intervention and outcomes. OBJECTIVE: To determine the prevalence of radiographic features of FAI in patients diagnosed
with FNSF. DESIGN: Retrospective case series. SETTING: Tertiary care,
institutional setting. PATIENTS: A medical records search program (Stanford
Translational Research Integrated Database Environment, Stanford University,
California) was used to retrospectively search for patients 18-40 years old with
a history of FNSF or FNSR. The records were obtained from the period July 25,
2003, to September 23, 2011. METHODS: For assessment of risk factors, plain
radiographs and magnetic resonance imaging studies were reviewed for features of
cam or pincer FAI. Medical records were reviewed to determine whether patients
required operative intervention. MAIN OUTCOME MEASURES: Incidence of abnormal
alpha (alpha) angle, abnormal anterior offset ratio, abnormal femoral head-neck
junction, coxa profunda, positive crossover sign, and abnormal lateral
center-to-edge angle. RESULTS: Twenty-one female and 3 male participants (mean
age 27 years, range 19-39 years) were identified with magnetic resonance imaging
evidence of femoral neck stress injury. Cam morphology was seen in 10 patients
(42%). Pincer morphology could be assessed in 18 patients, with coxa profunda in
14 (78%) and acetabular retroversion in 6 (14%). Features of combined pincer and
cam impingement were observed in 4 patients (17%). Seven patients (29%) had
operative intervention, with 3 (12%) requiring internal fixation of their femoral
neck fractures, and all had radiographic evidence of fracture union after
surgery. Four patients (17%) had persistent symptoms after healing of their FNSF
with conservative treatment and eventually required surgery for FAI, 3 had no
pain at final follow-up 1 year post-surgery, and one patient was lost to
follow-up. CONCLUSION: The results of the current study suggest that patients in
the general population with femoral neck stress injuries have a higher incidence
of bony abnormalities associated with pincer impingement, including coxa profunda
and acetabular retroversion, although it is unclear whether pincer FAI is a true
risk factor in the development of FNSF.
CI - Copyright (c) 2015 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS