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

Abstract

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.

Isoform 1 of Fibrinogen Alpha Chain Precursor is a Potential Biomarker for Steroid‐Induced Osteonecrosis of the Femoral Head

“…[ 11 ] SIONFH is a ischemic consequence of mcirovascular occulasion. [ 12 ] Therefore, the upregulation of FGA molecule identified in our study may play a role in the pathgenesis of SIONFH. Fibrin(ogen) derivatives and crosslinked fibrin nets are necessary for inflammation during tissue injury.…”

Emerging roles of growth factors in osteonecrosis of the femoral head

“…IGFBP-3 forms a ternary complex with IGF acid-labile subunit and either IGF-1 or IGF-2. In this form, it circulates in plasma, prolonging the half-life of IGFs and altering their interaction with cell surface receptors (Ceda, 1995;Dar et al, 2010;Moya-Angeler et al, 2015).…”