Resident Physician Mt. Sinai New York, New York, United States
Case Diagnosis: Femoral Stress Fracture
Case Description: A 62 year old female presented to an outpatient clinic with a 6 month history of progressively worsening lateral hip pain. Pain began in the setting of increased activity and is severe, constant, and localized to the lateral thigh with radiation to the lateral knee. Aggravated with ambulation, ascending stairs, and laying on her right side. Alleviating factors include ice and Advil. She had initiated physical therapy with only modest relief. Physical exam revealed painless hip ROM, however she had tenderness to palpation over the right greater trochanter and displayed evidence of weak hip abduction. She was diagnosed with greater trochanter pain syndrome and received a greater trochanter bursa corticosteroid injection. On reevaluation her symptoms had progressed thus a MRI was ordered which revealed trochanteric bursitis and a tensile femoral neck stress fracture. Orthopedics was consulted and she underwent total hip arthroplasty
Discussions: Femoral stress fractures (FSFs) are uncommon fractures and when encountered are mostly most often seen in athletes and military recruits or in the elderly with osteoporosis. FSFs are caused due to an imbalance of bone metabolism and inadequate bone formation in the setting of increased stress. FSFs typically present with vague anterior groin pain +/- radiation to the knee. In tensile type FSF treatment includes non weight bearing and urgent orthopedic referral.
Conclusions: In this case the patient presented with history and exam consistent with greater trochanter pain syndrome, however this ultimately overshadowed and clouded the diagnosis of femoral stress fracture.
Further imaging is indicated when patients fail to respond to standard treatment and a broad differential diagnosis should always be considered when treating hip pathology.
