Insufficiency stress fractures of the femoral neck in elderly women.

Thirteen insufficiency stress fractures of the femoral neck in 13 elderly patients (average age, 82 years) were studied retrospectively. All occurred in Caucasian women with severe osteoporosis. A vague pain about the hip, of spontaneous onset, was the main symptom on first visit. The diagnosis was delayed in most cases because the clinical findings were minimal and the early roentgenographic features were absent or subtle. Bone scintigraphy was found more useful than roentgenography for diagnosing this entity. A completely displaced stress fracture of the femoral neck could not be distinguished clinically or roentgenographically from a traumatic subcapital femoral fracture. Internal fixation was the treatment method associated with the more favorable results. The histologic examination of removed femoral heads indicated that this entity is a dynamic metabolic process. Insufficiency stress fractures of the femoral neck in the elderly are not uncommon, but unless suspected, the condition can be easily overlooked, and if displaced, mistaken for trauma-induced subcapital femoral fractures.