title: Femoral Neck Stress Fractures in Children Younger Than 10 Years of Age.
abstract: BACKGROUND
  Femoral neck stress fractures are rare in healthy children, with only 9 cases previously reported. The present article reviews our institutional experience with femoral neck stress fractures in children younger than 10 years of age, to highlight the unique features of this condition.
  
  
  METHODS
  We undertook a retrospective review of clinical records of patients who had been treated at our institution for an idiopathic femoral neck stress fracture between 2000 and 2014. To focus on children rather than adolescents, the World Health Organization's definition of adolescent as a person between 10 and 19 years of age was used; we thereby limited our analysis to patients younger than 10 years of age.
  
  
  RESULTS
  The study included 6 patients (3 males, 3 females) treated for an idiopathic femoral neck stress fracture, with a mean age at diagnosis of 7.7 years (range, 5.2 to 8.9 y). All patients presented with a limp, which worsened with activity and had persisted for a mean of 5 weeks (range, 2 to 9 wk). None of the patients had experienced an increase in activity level or sporting volume before symptom onset. On examination, 3 patients experienced pain with terminal hip flexion and 3 patients demonstrated pain-free hip range of motion. Plain radiography demonstrated inferior femoral neck cortical disruption, suggesting a compression-type stress fracture mechanism. The diagnosis was confirmed by cross-sectional imaging in all cases. All patients were initially treated with 6 to 8 weeks of non-weight-bearing followed by 4 to 6 weeks of partial weight-bearing, leading to complete healing in 4 patients. Two patients demonstrated incomplete healing and were managed with spica casting for an additional 6 weeks.
  
  
  CONCLUSIONS
  Our case series illustrates the unique features of this rare condition in children, with a history and examination profile distinct from those of adolescents and adults. Compliance with weight-bearing restrictions is difficult in this population and hip spica casting may be required to permit complete healing.
  
  
  METHODS
  Level IV-case series.
authors.affiliation: *Department of Orthopaedic Surgery, Harvard Medical School, Children's Hospital Boston, Boston †Department of Pediatric Orthopaedics, Starship Children's Hospital, Auckland, New Zealand ‡Department of Pediatric Orthopaedics, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Boyle
authors.forename: Grant D
authors.initials: GD
authors.lastname: Hogue
authors.forename: Benton E
authors.initials: BE
authors.lastname: Heyworth
authors.forename: Kathryn
authors.initials: K
authors.lastname: Ackerman
authors.forename: Bridget
authors.initials: B
authors.lastname: Quinn
authors.forename: Yi-Meng
authors.initials: YM
authors.lastname: Yen
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005265:Femoral Neck Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D015775:Fractures, Stress / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult