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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 12, 1574-1579.
doi: 10.1302/0301-620X.88B12.17996  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Long-term outcome of undisplaced fatigue fractures of the femoral neck in young male adults

H. K. Pihlajamäki, MD, PhD, Orthopaedic Surgeon, Adjunct Professor1; J.-P. Ruohola, MD, Research Fellow2; M. Weckström, MD, Research Fellow1; M. J. Kiuru, MD, PhD, MSc, Radiologist, Adjunct Professor3; and T. I. Visuri, MD, PhD, Orthopaedic Surgeon, Adjunct Professor1

1 Department of Orthopaedic Surgery
2 Research Institute of Military Medicine, Central Military Hospital, P. O. Box 50, FIN-00301 Helsinki, Finland.
3 Department of Radiology, Helsinki University Central Hospital, P. O. Box 266, FIN-00029 HUS, Helsinki, Finland.

Correspondence should be sent to Dr H. K. Pihlajamäki; e-mail: harri.pihlajamaki{at}helsinki.fi

The incidence and long-term outcome of undisplaced fatigue fractures of the femoral neck treated conservatively were examined in Finnish military conscripts between 1970 and 1990.

From 106 cases identified, 66 patients with 70 fractures were followed for a mean of 18.3 years (11 to 32). The original medical records and radiographs were studied and physical and radiological follow-up data analysed for evidence of risk factors for this injury. The development of avascular necrosis and osteoarthritis was determined from the follow-up radiographs and MR scans.

The impact of new military instructions on the management of hip-related pain was assessed following their introduction in 1986. The preventive regimen (1986) improved awareness and increased the detected incidence from 13.2 per 100 000 service-years (1970 to 1986) to 53.2 per 100 000 (1987 to 1990). No patient developed displacement of the fracture or avascular necrosis of the femoral head, or suffered from adverse complications. No differences were found in MRI-measured hip joint spaces at final follow-up. The mean Harris Hip Score was 97 (70 to 100) and the Visual Analogue Scale 5.85 mm (0 to 44).

Non-operative treatment, including avoidance of or reduced weight-bearing, gave favourable short- and long-term outcomes. Undisplaced fatigue fractures of the femoral neck neither predispose to avascular necrosis nor the subsequent development of osteoarthritis of the hip.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General