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  1. Optimum management of Femoral Neck Stress Fractures.

    We would like to thank Petrin et al for an informative case report[1] on an important injury sustained in athletes and service personnel. We agree that a high degree of suspicion for stress fractures should be maintained as we have previously reported the problems with a missed femoral neck stress fracture[2], and the more literature that is available highlighting these training injuries is useful for medical staff looking after athletes and servicemen[3].

    We note and thank you, that you reference our paper a couple of times in your article[4]. However, we believe that you have inadvertently slightly miss represented our work and we would like to take this opportunity to correct it.

    We do not state that "surgical fixation with percutaneous nail fixation is the treatment of choice in the management of tension type femoral neck fractures", as whilst we strongly believe that operative management is the most appropriate treatment for these fractures, we also think that the fracture should be treated with the most appropriate device available, as in our case report[2], where the patient was treated with a dynamic hip screw. Whilst in some cases an inter-medullary device would be appropriate, there is a higher cost and periprosthetic fracture risk using these devices. To our knowledge there is no evidence supporting the use of an inter-medullary device over a dynamic hip screw in the treatment of tension-type femoral stress fractures. We would also draw your attention to our paper Femoral Neck Stress Fractures in Sport: A Current Concepts Review[5] which details this type of stress fracture further.

    We thank the authors for an excellent case report and are grateful for the opportunity to clarify our stance on internal fixation of these fractures.

    References:

    1. Petrin Z, Sinha A, Gupta S, Patel MK. Young man with sudden severe hip pain secondary to femoral neck stress fracture. BMJ Case Rep 2016. doi:10.1136/bcr-2016-216820

    2. Thomas R, Wood AM, Watson J, Arthur CHC, Nicol AM. Delay in Diagnosis of Neck of Femur Stress Fracture in a female military recruit. J Royal Naval Medical Service 2012, Vol 98.2 27-29

    3. Wood AM, Keenan ACM, Arthur C, Wood IM. Common Training Injuries Concerning Potential Royal Marine Applicants. J Royal Naval Medical Service 2011, 97.3 106-109

    4. Wood AM, Hales R, Keenan A, et al. Incidence and time to return to training for stress fractures during military basic training. J Sports Med 2014;2014:282980.

    5. Robertson G, Wood AM. Femoral Neck Stress Fractures in Sport: A Current Concepts Review. Under Consideration Sports Medicine International SMIO-10-2016-0014-re

    Conflict of Interest:

    None declared

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