Complete and incomplete femoral stress fractures in the adolescent athlete

Stress fractures of the lower extremities are a known risk of intense physical activity. Femoral stress fractures represent a small subset of lower extremity stress fractures but can have grave consequences if undetected, resulting in a displaced fracture. If detected prior to displacement, conservative treatment of these fractures is highly successful. However, displacement frequently makes surgical treatment necessary. Unfortunately these fractures are often difficult to detect. Symptoms of stress fractures are frequently vague, particularly in femoral stress fractures. Specific physical examination techniques can assist in diagnosis but require a very high index of suspicion. Plain radiographs are also frequently negative in early stress fractures, further confounding diagnosis, and bone scan or magnetic resonance imaging studies are frequently needed. We present a case of an otherwise healthy 15-year-old male athlete with bilateral femoral stress fractures. The patient reported bilateral knee pain of 2 months' duration with physical activity, but had not curtailed his activities. His pain had been evaluated with plain radiographs, which were interpreted as normal. Immediately prior to presentation, while playing lacrosse, he sustained a displaced right supracondylar femur fracture. On further evaluation with bone scan he was found to have a contralateral nondisplaced supracondylar femoral stress fracture. His displaced fracture was managed with a retrograde intramedullary nail and his nondisplaced fracture was treated conservatively.