Acetabular Retroversion in Military Recruits with Femoral Neck Stress Fractures

• Published in: Clinical orthopaedics and related research Vol. 468; no. 3; pp. 846 - 851
• Main Authors: Kuhn, Kevin M., Riccio, Anthony I., Saldua, Nelson S., Cassidy, Jeffrey
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-03-2010; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Acetabulum - diagnostic imaging; Acetabulum - pathology; Adolescent; Adult; Biological and medical sciences; California - epidemiology; Clinical Research; Comorbidity; Conservative Orthopedics; Diseases of the osteoarticular system; Femoral Neck Fractures - complications; Femoral Neck Fractures - epidemiology; Femoral Neck Fractures - pathology; Fractures, Stress - complications; Fractures, Stress - epidemiology; Fractures, Stress - pathology; Hip Dislocation - complications; Hip Dislocation - epidemiology; Hip Dislocation - pathology; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Medicine; Medicine & Public Health; Military Personnel; Orthopedics; Radiography; Retrospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Traumas. Diseases due to physical agents; Young Adult; Neck Shaft Angle; Stress Fracture; Radiographic Abnormality; Femoral Neck; Pelvic Tilt; Femoral neck; Retroversion; Orthopedics; Diseases of the osteoarticular system; Acetabulum; Stress fracture; Bone; Trauma; Military
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-009-0969-5

Acetabular retroversion (AR) alters load distribution across the hip and is more prevalent in pathologic conditions involving the hip. We hypothesized the abnormal orientation and mechanical changes may predispose certain individuals to stress injuries of the femoral neck. We retrospectively reviewed the anteroposterior (AP) pelvic radiographs of 54 patients (108 hips) treated for a femoral neck stress fracture (FNSF) and compared these radiographs with those for a control group of patients with normal pelvic radiographs. We determined presence of a crossover sign (COS), femoral neck abnormalities, and neck shaft angle. The prevalence of a positive COS was greater in patients with stress fractures than in the control subjects (31 of 54 [57%] versus 17 of 54 [31%], respectively) and higher than for control subjects reported in the literature. Thirteen patients had radiographic changes of the femoral neck consistent with femoroacetabular impingement (FAI). These radiographic abnormalities were seen more commonly in retroverted hips. A greater incidence of AR was noted in patients with FNSF. Potential implications include more aggressive screening of military recruits with AR and the new onset of hip pain. Finally, we present an algorithm we use to diagnose and treat these relatively rare FNSFs.
Level of Evidence:
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.