Atypical Longitudinal Femoral Shaft Stress Fracture in a Young Runner: A Case Report

Case Diagnosis: A 25-year-old female runner with an unusual stress fracture location.

Case Description or Program Description: A 25-year-old female presented with a three-week history of right hip pain after increasing her running distance in preparation for a half marathon. Examination revealed anterolateral hip tenderness, mild limp, and pain during single-leg stance and hopping. Initial radiographs were negative. MRI revealed an incomplete longitudinal intracortical stress fracture of the medial proximal femoral shaft with associated marrow and peri-osseous edema. CT scan confirmed a 5 cm nondisplaced fracture along the medial cortex of the proximal femur. Risk factors included recent onset of high-intensity running, irregular menstrual cycles, and vitamin D insufficiency. The patient was instructed to discontinue running, limit weight-bearing, and start vitamin D supplementation.

Setting: Outpatient Sports Medicine/PM&R Clinic

Assessment/Results: Follow-up imaging at one and three months showed progressive healing with callus formation along the fracture line. The patient regained normal gait, had complete pain resolution, and resumed low-impact exercise without symptom recurrence.

Discussion (relevance): Stress fractures are common among runners; however, the location and orientation of the fracture in this case are unusual. Typically, stress fractures in the lower limb present as transverse and perpendicular to the cortical shaft, in contrast to the longitudinal fracture seen in this case. Early diagnosis and prompt conservative therapy are essential for preventing fracture-related complications and ensuring optimal recovery. This case highlights the importance of considering atypical fracture locations for runners with persistent hip pain not evident on initial radiographs.

Conclusions: Proximal femoral shaft stress fractures are rare and carry a risk of displacement and compromised structural integrity. Management of these atypical stress fractures requires advanced multimodal imaging, risk factor assessment, and coordinated multidisciplinary care to ensure accurate diagnosis and effective treatment. This case serves as an important reminder of the need for high clinical suspicion and comprehensive investigations in runners presenting with persistent hip pain.