Atraumatic Subtrochanteric Stress Fracture in a 45-Year-Old Housewife: Diagnostic Challenge and Management Strategy

Introduction: Subtrochanteric stress fractures are rare and often underdiagnosed due to their subtle clinical presentation and inconspicuous early radiological findings. While these fractures are frequently seen in elderly osteoporotic individuals or those on bisphosphonate therapy, they are uncommon in younger, premenopausal women without significant risk factors. This case highlights a rare instance of a non-displaced subtrochanteric stress fracture in a 45-year-old woman with osteopenia. Case Report: A 45-year-old housewife presented with a progressively worsening, insidious pain in the anteromedial aspect of her left proximal thigh for the past month and a half. The pain, which worsened with activities, such as climbing stairs and squatting, was non-traumatic and unrelieved by rest. Initial radiographs showed no abnormalities, prompting a magnetic resonance imaging (MRI), which revealed a non-displaced subtrochanteric stress fracture with surrounding bone marrow edema. A DEXA scan confirmed osteopenia (T-score of -2.1 at the femoral neck), and laboratory tests were within normal limits.Management and Outcome: Conservative management was initiated, including strict non-weight-bearing for 6-8 weeks, followed by partial weight-bearing, physiotherapy, and calcium and vitamin D supplementation. At 8 weeks, the patient reported significant pain relief and improved functional mobility. A follow-up MRI at 6 months demonstrated complete healing with no signs of delayed union or cortical disruption. Conclusion: In this case, a non-displaced subtrochanteric stress fracture in a premenopausal woman without bisphosphonate use or antecedent trauma presented as unexplained proximal thigh pain with normal initial radiographs. MRI enabled early diagnosis, and conservative management with non-weight-bearing and metabolic optimization resulted in complete fracture healing without the need for surgical intervention.