Hip Injury - Military Training

Hip Injury - Military Training Authors: Brian Laverentz, Courtney Hintz, Drew Johnson, Cody Butler HISTORY: An 18-year-old male Air Force Special Warfare trainee with a history of bilateral tibial bone stress injuries was completing a series of sprints. On the final sprint, he felt a pop, fell to the ground in pain and was unable to stand or ambulate. He endorsed mild right hip pain for approximately one week prior to the incident, which he believed was muscle soreness, and had not brought this complaint to medical personnel. He had completed seven weeks of basic training followed by eight additional weeks of Special Warfare training with gradually increasing weekly mileage. PHYSICAL EXAMINATION: Evaluation in the field was notable for an inability to bear weight with tenderness to palpation generalized over the right hip. He was unable to perform range of motion testing due to pain. A leg length discrepancy was noted with the right leg being shorter than the left. Evaluation of pulses in the right distal extremity were 2+ and sensation was normal. DIFFERENTIAL DIAGNOSIS: 1.Muscle/tendon tear2.Stress fracture of the femoral neck3.Slipped capital femoral epiphysis4.Avascular necrosis of the femoral head TEST AND RESULTS: Frontal 2-view pelvis radiographs: Complete, displaced angulated fracture through the base of the right femoral neck. DEXA Z scores at L1-L4 of -1.1, left femoral neck -1.6, left femoral total -1.2 Total testosterone 216 ng/dL, free testosterone 56 ng/dL, LH 2.5 IU/L, FSH 3.3 IU/L, 25-OH Vit D 34 ng/mL, PTH 42.7 pg/mL, TSH 1.37 mIU/L, and free T4 1 mIU/L. FINAL/WORKING DIAGNOSIS: Displaced femoral neck fracture secondary to bone stress injury TREATMENT AND OUTCOMES:1.Open reduction and internal fixation2.3 month period of non-weight bearing 3.Bi-Weekly rehabilitation including physical therapy and progressive weight loading over 6 weeks before return to training. 4.Vitamin D supplementation 5.Endocrine consultation6.Consultation with dietitian