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Basicervical femoral neck stress fracture
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Hello. I finished Challenge Roth (9th of July) with a lot of pain in my higher thigh/hip area. Two days after they took a x-ray, which did not show any bone fracture. However, 10 days after the pain was still there. So, a magnetic resonance confirmed a stress fracture on the base of the femoral neck. Due to the fact that 80% of the bone was cracked (only 20% of the bone staying together), the doctor recommended having surgery in order to avoid total fracture and displacement. I agreed and had surgery on the 28th of July (one month ago). They introduced a dynamic hip screw (attached post operative x-ray. A plate with two screws in my femur shaft + a needle towards the head of the femur). Now I am walking with crutches until the follow-up in 10 days time (6 weeks form surgery). Meanwhile I am doing some easy swim with buoy and some easy spin (with no load) on the trainer, just to get the lost flexibility back. If they see signs of healing on the control x-ray, I can probably skip the crutches and start swimming with no buoy and adding some load on the bike (maybe even cycling outdoors)... I know having a surgery was maybe the safest option. However, I am worried that even when the bone heals, if I could ever run with the metalic material I have inside or if I would need to get them removed before I start running again. From what I understand, they do not remove the hardware before six months after the surgery and after this second surgery I would need to be on crutches for 6 weeks again, until the bone fills the holes left by the screws. I was just wondering if anyone here has experience with such DHS implants and if they need to be removed after the bone has healed before starting running. Thanks in advance. Jon
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Re: Basicervical femoral neck stress fracture [Jontxu] [ In reply to ]
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Generally speaking hardware removal cannot occur before stability of the bone and relatively normal functioning. One may opt to have hardware removed and many physicians will do so if pain is getting in the way of life. Don't rush things, see how it goes with time. More concerning, how did you sustain a stress fracture across 80% of your femoral neck without trauma in an otherwise healthy individual? The way this is fixed is similar to how elderly individuals get their hips pinned when they fall and fracture (typically without the plate however). Did you ignore pain for a long time? Is there a metabolic disorder going on?
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Re: Basicervical femoral neck stress fracture [Calvinbal6] [ In reply to ]
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Hello Calvinbal6. I think they put a plate because it was not purely neck fracture. It was an extracapsular fracture. They called it pertrochanteric fracture, between the base of the neck and the trochanters. Actually, I started feeling some sore area one week before Challenge Roth but I ignored it since it was not a big pain. I managed to finish the race but after it cooled down the pain was quite sharp. It was not until 2 weeks after through a magnetic resonance I learnt I had a stress fracture since the x-ray two days after the race did not show anything. I will have a follow-up x-ray next week and see how the bone is healing. The x-ray after 6 weeks would show something even the x-ray at the beginning did not show? About the metallic stuff, I can understand that some pins would not bother anything but a plate? That is a bigger thing. How long after the surgery they usually remove the metal stuff?
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Re: Basicervical femoral neck stress fracture [Jontxu] [ In reply to ]
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Good luck with your rehab. Sounds like the sort of thing where you just need to be patient. Which is probably not easy.
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Re: Basicervical femoral neck stress fracture [Jontxu] [ In reply to ]
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The X-ray may not show fracture until weeks after it occurred, especially if healing has already commenced. Since you had surgery, it may take at least 6 months to a year before your surgeon would be willing to discuss hardware removal. the positive of hardware in your body is the bone is stabilized and you can place some stress through it without fear of injury.
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Re: Basicervical femoral neck stress fracture [Calvinbal6] [ In reply to ]
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Thanks Calvinbal6 for your reply. What you mean is that if the bone healing has started we should be able to identify the fracture even the initial x-ray did not show it. At the time the magnetic resonance showed the fracture, the doctor recommended to have surgery since she saw a risk of displacement. I listened to her and had the surgery but now I have my doubts if the non-operative non-weight-bearing procedure was the best. I am reading in some forums that in the long term having no surgery has better recovery but I do not know since the non-surgery had its own risk as well. Do you think choosing the surgery was a good option?
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Re: Basicervical femoral neck stress fracture [Jontxu] [ In reply to ]
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If there is a fracture there, then the X-ray should have shown it regardless of how long after the injury. It may have been missed as sometimes with hairline fractures they can be hard to spot depending on the angle that it is taken at. I've not come across fractures being more easy to spot once they have had longer to heal.

My immediate thought is that going straight for surgery was a bit of a snap reaction. I'm a physio and have dealt with a lot of fractures conservatively. Obviously can't comment on your individual case, but if it was a stress fracture I'm quite surprised they operated so quickly. Only thing I can think of is if you had an element of avascular necrosis in the head of the femur which would have indicated a quick surgical intervention to prevent the bone from devascularising, and then yes, being a big problem.

It is too late now anyway as you have had the surgery. Rehab as best as you can and see where it takes you. Having metalwork in your leg shouldn't stop you from returning to triathlon in the longer term.
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Re: Basicervical femoral neck stress fracture [Ironmike78] [ In reply to ]
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Hello Ironmike78. Thanks for your reply. The surgeon said that 80% of the bone was cracked and she was afraid of having a complete fracture with a consequent displacement, which would be a devastating problem in her opinion. I think that is why she recommended surgery. I did not have any second opinion and followed her advice which I hope it is fine.
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Re: Basicervical femoral neck stress fracture [Jontxu] [ In reply to ]
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Hey there! I know this is an old thread but just wondering how you recovered and if you’ve managed to get back to running/training? In a similar situation myself and it’s been a tough journey so far...
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Re: Basicervical femoral neck stress fracture [Jontxu] [ In reply to ]
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Like some else said hardware (usually) is only removed when it becomes painful. With that kind of break you don't need to rush things. One of the long term problems is necrosis of the femur head. Breaks in the femur neck and surgery can cause over time a decreases of blood supply to the head of the femur and it dies. That means your getting a total hip replacement.

If you heal and your MD says you can train again (especially running) and you don't have any pain why would you want the hardware removed?
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