Surgical treatment of a femoral neck stress fracture without endocrinal comorbidity in an amateur sportswoman

Stres prijelomi nisu česte ozljede te većinu pacijenata čine vojnici i sportaši koji su podvrgnuti teškim fizičkim naporima. Stres prijelomi vrata bedrene kosti najčešće se događaju u dobi od 18 do 35 godina i takvi pacijenti često boluju od nekog endokrinološkog poremećaja. Inicijalne rentgenske snimke kostiju kuka su uredne. MR dijagnostika kuka imperativ je za dijagnostiku takvog prijeloma. Vrsta tretmana ovisi o tipu prijeloma − kompresivni zahtijeva konzervativno liječenje, a tenzijski operativno liječenje. U našem prikazu slučaja prezentirali smo tridesetpetogodišnju sportašicu amaterku u vožnji na koturaljkama koja je unatrag šest mjeseci patila od neprepoznatih simptoma stres prijeloma vrata bedrene kosti. Klinički pregledi, RTG slike bolnog kuka, endokrinološka i denzitometrijska testiranja nisu pokazivala patološke rezultate. Na kraju je MR dijagnostika bolnog kuka pokazala značajan stres prijelom vrata bedrene kosti koji je bio indikacija za hitan operacijski tretman. Oporavak pacijentice nakon minimalno invazivnog operacijskog tretmana osteosinteze prijeloma kanuliranim vijcima bio je vrlo brz. Liječenje je završilo devet mjeseci nakon operacije, s potpuno urednim kliničkim statusom i punom sportskom aktivnošću. U slučaju nejasnih opetovanih bolova u ingvinalnoj regiji imperativ je, unatoč urednim nalazima RTG slika kuka, endokrinoloških laboratorijskih testova i denzitometrije kostiju, zbog sumnje na stres prijelom vrata bedrene kosti, pravovremeno napraviti MR dijagnostiku bolnog kuka. Takvim pristupom ovom patološkom problemu postiže se najbolji rezultat liječenja i izbjegavaju se dalekosežne posljedice tretmana komplikacija takvog prijeloma zbog previda.Stress fractures are not frequent injuries and mostly soldiers and sports people faced with severe physical exertion suffer from this kind of pathology. Most patients with femoral neck stress fracture are 18−35 years of age and often suffer from a certain endocrinal comorbidity. The clinical status of this pathology is often not followed by positive x-ray signs of fracture. MRI is an imperative in diagnostics of this pathology. These fractures are treated according to type of fracture – compression fracture is treated conservatively and tension fracture operatively. In our report we present a case of a 35-year-old roller skating amateur sportswoman who suffered from unrecognized symptoms of femoral neck stress fracture over six months. There was no sign of pathology according to the repeated clinical exams, x-rays of the painful hip, endocrinal and densitometry tests. Finally, MRI diagnostics detected a remarkable femoral neck tension stress fracture which was an indication for urgent operative treatment. The patient\u27s recovery after the minimally invasive osteosynthesis with cannulated screws was very fast. Her treatment was finished after nine postoperative months with a regular clinical status and full sports activity. In case of undefined recurrent pain in the inguinal region, despite a regular x-ray of the hip, endocrinal lab tests and densitometry results, it is imperative to perform an MRI of the painful hip because of suspicious femoral neck stress fracture. The described approach to this pathologic problem will lead to the best results of therapy and avoid far-reaching consequences of treating complications of such a fracture caused by a mistake