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Published on: November 13, 2016
Cephalomedullary Nail Fixation for Prophylactic Treatment of Incomplete Femoral Neck Stress Fractures in Athletes
Christopher J McMellen1, Margaret A Sinkler1, Ethan Winter2
1Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Background:
The traditional management of femoral neck stress fractures (FNSFs)-such as cannulated screw fixation-requires a period of protected weightbearing and does not provide fixed angle stability.
Purpose:
To report the technique and outcomes of a single surgeon's case series of prophylactic fixation of incomplete FNSFs using cephalomedullary nailing (CMN) followed by immediate weightbearing.
Study Design:
Case series; Level of evidence, 4.
Methods:
A retrospective review of 17 FNSFs treated using CMN by a single surgeon over 7 years was conducted. descriptive, injury, and treatment-related data were collected. Perioperative complications and recovery courses were included for each case. Descriptive statistics were used to summarize the characteristics, clinical presentation, diagnostic imaging findings, treatment details, and follow-up outcomes of the study population.
Results:
There were no perioperative complications across the 17 injuries. The mean intraoperative blood loss was 67 mL (range, 20-150 mL). In all 17 cases, immediate full weightbearing was recommended. All patients were able to initiate a return to running by 6 weeks postoperatively. Time until completion of narcotic use was noted for 15 cases, with narcotic medications no longer required at 2 weeks for 12 injuries (71%), at 6 weeks for 2 injuries (12%), and at 3 months for 1 injury (5.9%). Patients had a mean of 12.4 months of follow-up (range, 6-48 months). At the final follow-up, 5 cases (29%) had persistent pain-1 from gluteus medius tendinosis and 4 from painful distal interlocking screws. Two patients underwent the removal of symptomatic hardware.
Conclusion:
This study demonstrated that prophylactic fixation of FNSFs with CMN in endurance athletes is a safe and effective construct that permits early return to baseline impact activity because of the inherent stability of the construct, with a favorable complication profile-although with a 30% rate of persistent pain from the surgical site.
