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Tension-Sided Femoral Neck Stress Fracture in a Skeletally Immature PatientA Case Report
Ronald A. LehmanJr., MD1; Suken A. Shah, MD2
1 Department of Orthopaedic Surgery and Rehabilitation, Walter Reed Army Medical Center, 6900 Georgia Avenue N.W., Washington, DC 20307
2 Department of Orthopaedic Surgery, Nemours Children's Clinic-Wilmington, Alfred I. duPont Hospital for Children, 1600 Rockland Road, P.O. Box 269, Wilmington, DE 19899.
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
The views expressed in this paper are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the United States Government.
Investigation performed at Alfred I. duPont Hospital for Children, Wilmington, Delaware, and Walter Reed Army Medical Center, Washington, DC

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Jun 01;86(6):1292-1295
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Extract

Afemoral neck stress fracture in a skeletally immature individual is a rare event. To our knowledge, only fourteen cases have been reported in the literature1-5. Several authors have devised systems to classify these fractures2,3,6. Stress fractures usually show no initial fracture line radiographically but rather demonstrate a gradual alteration of the trabeculae due to repetitive or overuse activity6. As a result, the diagnosis of stress fracture is infrequently considered when a child presents with a limp along with persistent or recurring pain in the hip, the anterior portion of the thigh, or the knee. To our knowledge, the few cases that have been reported in the literature have all occurred on the compression (medial) side of the femoral neck1-5. Blickenstaff and Morris stated that only compression-sided stress fractures can occur in children6.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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