Bilateral neck of femur stress fractures in unilateral hip pain: Is magnetic resonance imaging (MRI) of the contralateral hip necessary?

BACKGROUND: Stress fractures may occur in healthy individuals following repetitive physical loading. They account for up to 10% of all orthopaedic injuries but rarely involve the femoral neck. CASE PRESENTATION: We are reporting a young adult presenting with unilateral hip pain who was ultimately diagnosed with bilateral femoral neck stress fractures. Magnetic Resonance Imaging (MRI) revealed an occult contralateral fracture not visible on plain radiographs. Bilateral screw fixation was performed, with an excellent outcome at two years. DISCUSSION: In this patient, stress fractures occurred on the bilateral femoral neck secondary to his intensive training for fire brigade recruitment involving running and repetitive jumping jacks. Although the patient presented with unilateral hip pain, given the history and the nature of his job, it is important to screen the contralateral hip to prevent misdiagnosis. CONCLUSION: The patient underwent bilateral neck of femur screw fixation and demonstrated an excellent outcome at 2-year post-operative follow-up. This case emphasizes the need for high suspicion and routine MRI of both hips in similar presentations.