MRI in a 20-year-old female distance runner shows a stress fracture of the superolateral (tension side) cortex of the femoral neck. Which is the correct management?

• A Immediate surgical fixation followed by protected weight bearing ✓
• B Strict non-weight-bearing until union, then gradual rehabilitation
• C Graduated return to running after 4 weeks of relative rest
• D Continue training with analgesics and weekly review

Explanation

Tension-side (superolateral) femoral neck stress fractures are unstable and carry a high risk of displacement, nonunion and avascular necrosis, so they require urgent operative fixation with screws. Compression-side fractures on the inferomedial cortex can often be managed non-operatively with protected weight bearing if undisplaced, which makes option B the classic distractor. Continuing to run risks complete fracture and is never acceptable once imaging confirms a tension-side lesion.

Reference: Miller's Review of Orthopaedics, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.