Treatment of Small Stress Fracture of the Inferior Femoral Neck
A small stress fracture of the inferior (medial/compression-type) femoral neck should be treated with strict non-weight-bearing for 6-8 weeks followed by gradual return to activity, with close radiographic monitoring every 2-3 weeks to ensure the fracture is not progressing to displacement. 1, 2
Critical Classification Determines Management
The location of your fracture on the inferior (medial/compression) side is the single most important factor that allows conservative management 1, 2:
- Medial "compression-type" femoral neck stress fractures are considered low-risk and can be managed non-operatively 1
- In contrast, lateral "tension-type" femoral neck stress fractures are inherently unstable, prone to displacement, and require percutaneous screw fixation 1, 3
- This distinction is critical because femoral neck stress fractures overall are classified as high-risk due to increased rates of delayed union, nonunion, displacement, and avascular necrosis 1, 3
Conservative Management Protocol
For your compression-type fracture, follow this specific algorithm 2, 4:
- Strict non-weight-bearing with crutches for 6-8 weeks 2, 4
- Serial radiographs every 2-3 weeks to monitor for any progression or displacement 2, 5
- Pain should guide activity—continue protected weight-bearing until completely pain-free 2
- Gradual return to activity only after pain resolution and radiographic evidence of healing 4, 6
- Full return to sports typically requires 3-6 months 4
Critical Monitoring Requirements
Do not assume the fracture will remain stable—frequent follow-up is mandatory 2, 5:
- Any widening of the fracture line on serial radiographs mandates immediate surgical stabilization 2, 5
- Persistent or worsening pain despite appropriate conservative management requires repeat MRI to assess for complications 7, 4
- Progression to a displaced fracture carries devastating consequences including nonunion, avascular necrosis, and long-term disability 4, 1
When Surgery Becomes Necessary
Immediate surgical fixation with cannulated screws is indicated if 2, 4:
- Any cortical disruption or widening of the fracture line develops 2, 5
- The fracture shows any signs of displacement on follow-up imaging 2, 4
- Pain persists or worsens despite 6-8 weeks of protected weight-bearing 4
- There is any concern for progression based on MRI findings 4
Common Pitfalls to Avoid
Do not allow weight-bearing too early—this is the most common cause of progression to complete fracture 2, 5:
- Even compression-type fractures can displace if inadequately protected 5
- Muscle fatigue and loss of shock absorption contribute to fracture progression 5
Do not skip serial radiographic follow-up—delayed detection of progression can result in avascular necrosis and nonunion 5, 4, 6:
- Radiographs should be obtained every 2-3 weeks during the non-weight-bearing period 2
- Any change in fracture appearance requires immediate orthopedic consultation 2
Do not rely on symptom resolution alone—radiographic healing must be confirmed before advancing activity 4, 6: