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What Is a Stress Fracture of the Hip?

By Dr. Kevin J. Murphy




Sports Medicine Recovery Journal

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A stress fracture usually occurs when a bone is subjected to repetitive strain or impact. For example, when a runner's foot strikes a hard surface, the vibration from that impact travels up the leg to the hip. After a time, the hip bone (which is actually he head of the femur) can weaken and develop tiny fractures. Continued impacts prevent these fractures from healing, and eventually, the number and size of the fractures grow. This causes pain in the groin and hip area, and in some cases, the hip bone becomes displaced, meaning it is no longer aligned in its socket.

Hip stress fractures are most common among long-distance runners and other athletes who experience heavy, repeated leg impacts. In addition, people with low body mass (BMI), inadequate nutrition during a training program, or poor overall nutrition are at elevated risk for a hip stress fracture. Hip stress fractures can occur at any age.

How Are Hip Stress Fractures Treated?

Undiagnosed and untreated stress fractures can cause severe damage to the hip joint. Sometimes, the hip may go out of alignment or break. Therefore, when there is constant pain in the groin or front of the hip, it is important to consult with an orthopedic physician.

The diagnosis of a hip stress fracture will be confirmed by an X-ray, or, if the fracture is difficult to find, a bone scan or MRI. Treatment will depend on the severity of the fracture. In cases of mild pain and no major mobility impairment, crutches and a change in physical activity or nutrition may be recommended. When the fracture is large and the pain does not lessen with rest, or the hip bones are out of alignment, surgery may be the best option. Surgery is also recommended when the fracture is located on the femoral neck. This type of fracture is unlikely to heal on its own.

Generally, there are three surgical options for treating hip stress fractures. The best approach will depend on age, underlying health conditions, the severity and location of the hip fracture, and whether the fractured bone remains properly aligned.

  • Repair. Metal hardware, including screws and plates, is added to the hip to hold the fractured bone together. This allows the bone to knit together and heal.
  • Partial hip replacement. If the ends of the fractured bone are displaced or damaged, a partial hip replacement may be recommended. Typically, this involves removing the head and neck of the femur and replacing them with metal parts.
  • Total hip replacement. In more extreme cases where the hip bone is broken, displaced, or damaged, a total hip replacement is often recommended. During this procedure, the upper femur and the socket in the pelvic bone are both replaced with artificial parts.

Hip replacements are also recommended when a fracture has interrupted the blood supply to the ball of the hip joint. If this occurs, the bone is unlikely to heal properly unless there is surgical intervention.

Surgery is followed by rehabilitation. Physical therapy, which begins the day after surgery, focuses on increasing range-of-motion and strengthening the hip. Depending on the rate of recovery after surgery, patients may be sent home or to an extended care facility. Physical therapy will then continue as needed. An occupational therapist may also assist the patient with adjusting to daily life activities, such as toileting, bathing, dressing, and cooking. In some cases, a walker or wheelchair may be recommended to help restore mobility and independence. Pain medications may also be prescribed.

Pain in the hip or groin should not be ignored, especially if an individual is regularly engaged in rigorous physical activity. If the pain does not cease after rest, or pain reoccurs after putting weight or stress on the hip, it is time to consult an orthopedic physician.

Remember, we update our Sports Medicine Oregon blog monthly, so be sure to tune in often to stay up to date on the latest sports medicine news and views!

Sources:

Hip Fracture: Mayo Clinic Patient Care and Health Information - https://www.mayoclinic.org/diseases-conditions/hip-fracture/diagnosis-treatment/drc-20373472

Hip Stress Fracture Symptoms, Causes and Treatments: Very Well Health - https://www.verywellhealth.com/hip-stress-fracture-2549478

Stress Fracture of the Hip: UC San Diego Health/Orthopedics & Sports Medicine - https://health.ucsd.edu/specialties/surgery/ortho/hip/Pages/stress-fracture.aspx