Stress Fractures in Sport: Hip

Stress fractures about the hip are common overuse injuries in athletes which can result from increased stress on normal bone or normal stress on abnormal bone. The aim of this chapter is to review the epidemiology of the most common stress fractures of the hip, discuss optimal management of these stress fractures, and outline return to play following injury. Stress fractures can be divided into high risk and low risk categories based on their location. High risk stress fractures are defined as such due to their increased propensity for propagation, displacement, malunion, or nonunion if not treated appropriately, with immediate cessation of activity and surgical fixation. Tension-sided femoral neck stress fractures and atypical proximal femur fractures are two examples of high risk stress fractures in the hip. Low risk stress fractures have a much lower propensity for propagation and often do well non-surgically, with rest and activity modification. These include compression-sided femoral neck stress fractures and femoral shaft fractures. Thorough investigation and examination of patients with vague, poorly localized hip and thigh pain can lead to early diagnosis of stress fractures, improved recovery outcomes, and quicker return to play for athletes, with fewer complications.