Insufficiency fracture of the femoral head: MR imaging in three patients.

Abstract

Femoral head insufficiency fracture should be included in the differential diagnosis of hip pain in the osteopenic elderly patient.

Risk Factors Leading to Total Hip Arthroplasty in Patients with Subchondral Insufficiency Fractures of the Femoral Head

“…4,5,14 Protected weight bearing enabled successful resolution of hip pain, 1,3 and should be used as initial Figure 4 Receiver operating characteristic curves for patient age showing the optimal cut-off point of 71 years (arrow), with the highest sensitivity/specificity combination. management for stress fractures, such as SIF of the femoral head.…”

“…Nonetheless, we consider that treatment for osteoporosis, such as the administration of bisphosphonate, is beneficial for such patients, because osteoporosis is a major cause of fractures in the elderly and has been reported to contribute to SIF of the femoral head. [1][2][3][4][5][6] The main limitation of this study was the short follow-up period in the conservative group (mean, 28 months). The symptoms in these patients may deteriorate, and the patients may then require THA.…”

“…Presence of a subchondral linear or serpiginous pattern of low signal intensity on T1-weighted MRI corresponds histologically to such fractures. 2,[4][5][6] Some such fractures resolve spontaneously following conservative treatment, including protected weight bearing, 1,3 but in others the hip joint space rapidly disappears and/or the femoral head collapses and necessitates total hip arthroplasty (THA). 2,[4][5][6] We retrospectively evaluated factors leading to THA in patients with SIF of the femoral head.…”

“…The diagnosis of SIF was based on (1) hip pain that began without any apparent history of trauma; (2) radiographs that were normal or showed collapse of the femoral head; (3) a bone marrow oedema pattern in the femoral head and/or neck on MRI; and (4) a subchondral low signal intensity band on T1-weighted MRIs, which was either serpiginous or parallel to the articular surface. [1][2][3][4][5][6] Radiographic analyses included the Singh index 8 as a marker for osteoporosis and measurements of the type-C1 and -C2 lesions, the band occupies more than the medial two thirds of the weight-bearing portion, without and with lateral extension to the acetabular edge, respectively.…”

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

“…O sintoma principal era de dor na região inguinal, presente de duas a 16 semanas (média de oito semanas) antes da primeira consulta. Foram analisados A área de necrose inicialmente apresenta alto sinal em T1, mas posteriormente o sinal pode ser substituído por líquido ou esclerose (15) . O fator mais importante no prognóstico da osteonecrose é a estimativa da percentagem de superfície de carga comprometida (16) (Figura 3).…”