Importância do diagnóstico da fratura subcondral da cabeça do fêmur, suas diferenças com a necrose avascular e seu tratamento

Polesello, Giancarlo Cavalli; Sakai, Denis Seguchi; Ono, Nelson Keiske; Honda, Emerson Kiyoshi; Guimarães, Rodrigo Pereira; Júnior, Walter Ricioli

doi:10.1590/s0102-36162009000200003

Rev. bras. ortop.

2009

DOI: 10.1590/s0102-36162009000200003

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Importância do diagnóstico da fratura subcondral da cabeça do fêmur, suas diferenças com a necrose avascular e seu tratamento

Giancarlo Cavalli Polesello¹,

Denis Seguchi Sakai²,

Nelson Keiske Ono³

et al.

Abstract: A fratura subcondral da cabeça femoral é afecção pouco conhecida e, consequentemente, pouco diagnosticada. O quadro clínico de dor aguda ou insidiosa com piora progressiva na região inguinal, exacerbada com carga e com alívio em repouso, deve levar à suspeita diagnóstica. O erro comumente feito com o diagnóstico de necrose avascular da cabeça do fêmur pode induzir a indicação de procedimentos invasivos desnecessários no quadril. Com o advento da ressonância nuclear magnética, o diagnóstico dessa afecção pode s… Show more

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Cited by 4 publications

References 14 publications

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Differentiating Subchondral Insufficiency Fracture from Osteonecrosis May Help Avoid Unnecessary Total Hip Arthroplasty

et al. 2018

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Differentiation of subchondral insufficiency fracture (SIF) from osteonecrosis (ON) is clinically important. The purpose of this study is to correlate the X-ray and magnetic resonance imaging (MRI) findings in cases that have been diagnosed histopathologically as SIF or ON, define features on X-ray and MRI analysis, and identify clinical features that may aid in the diagnosis of SIF from ON. Two blinded radiologists evaluated 104 femoral heads that were diagnosed on histopathology as either ON or SIF. Radiographs and MRIs were evaluated for pertinent radiologic features. If a low signal intensity band was present on MRI, size/depth, shape (parallel/concave/serpentine), and consistency (fatty/edematous/fibrous/mixed) were characterized. About 48.1% of SIF cases were misdiagnosed on X-ray. On MRI, SIF was associated with the presence of a parallel band (p < 0.001), while ON was associated with a serpentine band (p < 0.001). Fifty-eight percent of SIF cases had low intensity signal bands that were fibrous (p < 0.001), while 86% of ON cases had mixed signal bands (p < 0.001). Mean depth for SIF and ON patients was 1.56 mm and 15.36 mm, respectively. Women with bone mineral density < − 1, and age > 50 years had higher odds of SIF (p = 0.047, p = 0.014, p = 0.034, respectively). SIF is often misdiagnosed on X-ray, and the presence, shape, quality, and depth of the band on MRI can help distinguish SIF from ON. Patients with inconclusive X-ray findings with clinical features that match potential SIF should be considered for MRI. It is reasonable to allow for nonoperative management before recommending operative procedures in patients suspected of having SIF, as these fractures may be possibly managed conservatively.

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Differentiating Subchondral Insufficiency Fracture from Osteonecrosis May Help Avoid Unnecessary Total Hip Arthroplasty

et al. 2018

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Bilateral bone marrow edema syndrome of the humeral head mimicking avascular necrosis: a case report

Cavanna¹,

Cavanna

2023

Egypt Rheumatol Rehabil

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Background Bone marrow edema syndrome (BMES), previously referred to as transient osteoporosis, is an uncommon and underdiagnosed self-limiting condition typically affecting the weight-bearing joints of the hip and lower limb. Its occurrence in upper limb or non-weight bearing joints is particularly rare. Case presentation We report the case of an otherwise healthy 42-year-old man who gradually developed severe and disabling left shoulder pain over the course of 6 months. Nine months after onset, he presented clinically with bilateral involvement and radiologically (magnetic resonance imaging, MRI) with diffuse BME associated with a subchondral insufficiency fracture, suggestive of proximal humeral avascular necrosis. Clinical evidence of subacromial shoulder impingement and MRI findings of bilateral subchondral bursitis and tenosynovitis with effusion of the biceps tendons likely resulted from primary BME, as musculoskeletal sonography confirmed the absence of rotator cuff tears. Repeated MRI findings at 2, 12, and 18 months documented near complete resolution of both edema and fracture, consistent with BMES of the proximal humerus. During this time, the patient reported a gradual improvement in both pain symptoms and range of motion. The clinical picture of insidious shoulder pain, exacerbated by activity and improved by load relief, in the absence of predisposing factors for osteonecrosis or antecedent trauma in patients of middle age, should indicate the possibility of the diagnosis of BMES. Conclusions This unprecedented report documents a rare case of bilateral BMES of the humeral head mimicking avascular necrosis. The correct diagnosis of BMES within an atypical anatomical location avoids invasive measures in the affected bone. The misdiagnosis of secondary BME and idiopathic osteonecrosis can be avoided by recognizing the characteristics of BME and subchondral fractures of the humeral head in the absence of rotator cuff tears, as well as their evolution on serial MRI.

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Arthroscopic Treatment of Collapsed Subchondral Fatigue Fracture in the Femoral Head of a Young Military Recruit at a 5-Year Follow-Up

Kim

Moon

Yoon

et al. 2019

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Case: A 20-year-old military recruit presented with pain in his left hip. He was referred by the military hospital for osteonecrosis of the femoral head in both hip joints. Plain radiographs and magnetic resonance imaging showed a marked collapse in the left femoral head; however, the patient was diagnosed as having subchondral fatigue fractures of the femoral head (SFFFH) after a thorough review of previous sequential images. Arthroscopic debridement and labral repair were performed. At 3 years after surgery, the patient was symptom-free and second-look hip arthroscopy revealed the articular defect filling with fibrocartilage on the femoral head. Conclusion: In a young patient, hip arthroscopy can be a successful joint preserving treatment option even for collapsed SFFFH.

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Importância do diagnóstico da fratura subcondral da cabeça do fêmur, suas diferenças com a necrose avascular e seu tratamento

Cited by 4 publications

References 14 publications

Differentiating Subchondral Insufficiency Fracture from Osteonecrosis May Help Avoid Unnecessary Total Hip Arthroplasty

Differentiating Subchondral Insufficiency Fracture from Osteonecrosis May Help Avoid Unnecessary Total Hip Arthroplasty

Bilateral bone marrow edema syndrome of the humeral head mimicking avascular necrosis: a case report

Arthroscopic Treatment of Collapsed Subchondral Fatigue Fracture in the Femoral Head of a Young Military Recruit at a 5-Year Follow-Up

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