Insufficiency fractures, an often unrecognized diagnosis

Verhaegen, Marleen; Sauter, A. J. M.

doi:10.1007/s004020050371

Cited by 13 publications

(6 citation statements)

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“…5), and intertrochanteric hip fractures. 3,6,8,10 Plain radiography combined with technetium bone scanning are mostly sufficient for detecting associated fractures.…”

Section: Discussionmentioning

confidence: 99%

“…1 Awareness of these injuries is inadequate, despite publication of several case reports since then. [1][2][3][4][5][6] Diagnosis is often delayed or missed. Most patients are elderly and present with intractable lower back pain; some complain of leg weakness but neurological impairment is rarely detectable.…”

Section: Introductionmentioning

confidence: 99%

“…7 The patients are often misdiagnosed as having spinal stenosis, degenerative disc disease, spondylolisthesis, spondylosis, compression fractures, or neoplasms. 6,8,9 Degenerative changes of the lumbar spine are often considered to be the only cause of the discomfort. Routine radiography of the spine and pelvis is usually inconclusive, and blood biochemistry may reveal elevated alkaline phosphatase levels.…”

Section: Introductionmentioning

confidence: 99%

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Sacral Insufficiency Fractures

Schindler¹,

Watura

Cobby

2007

J Orthop Surg (Hong Kong)

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“…5), and intertrochanteric hip fractures. 3,6,8,10 Plain radiography combined with technetium bone scanning are mostly sufficient for detecting associated fractures.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sacral Insufficiency Fractures

Schindler¹,

Watura

Cobby

2007

J Orthop Surg (Hong Kong)

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“…Some studies suggest that SIF of the femoral head may encourage rapidly progressive OA of the hip [10][11][12][13][14][15][16]. However, most insufficiency fractures occur as femoral neck fractures at the proximal femur during loading of the joint [17][18][19]; why do some occur instead in the subchondral area of the femoral head? Most recently, Fukui et al proposed that inversion of the acetabular labrum may be involved in subchondral insufficiency fracture with subsequent rapidly destructive hip OA [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Inversion of the acetabular labrum causes increased localized contact pressure on the femoral head: a biomechanical study

Fukui

Kaneuji

Hirosaki

et al. 2018

International Orthopaedics (SICOT)

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Purpose Although studies suggest that subchondral insufficiency fracture of the femoral head may cause rapidly progressive osteoarthritis of the hip, the mechanism of that relationship remains unclear. Our biomechanical study aimed to provide more data in this area by quantifying pressure distribution on the femoral head for normal and inverted hips and by determining the effects of labral inversion on pressure distribution across the joint, focusing on types of fracture under load. Methods We tested mid-sized fourth-generation composite femurs at 15°of adduction, and applied 1 mm/min of axial compressive force to the femoral heads until failure. Additionally, single loads (3000 N) were applied using Prescale film to investigate pressure distribution on the femoral head, with or without silicone rubber representing entrapment of an inverted acetabular labrum. ResultsIn tests with an external load of 3000 N, the mean pressure for 10 × 5 mm of silicone rubber was 11.09 MPa, significantly greater (about 5.7-fold) than 1.94 MPa without silicone rubber. Different fracture patterns were observed with and without the 10 × 5 mm silicone rubber; when the 10 × 5 mm silicone rubber specimens were used, all eight cases showed fractures in the anterior femoral head. Conclusions When silicone rubber representing an inverted acetabular labrum was placed between a hemispherical metallic platen and a composite bone model, the silicone rubber areas were subjected to extreme concentration of stress. The fractures that developed at the silicone rubber areas clearly represented subchondral fractures of the femoral head, rather than fractures of the femoral neck.Keywords Inverted acetabular labrum . Subchondral fracture of the femoral head . Rapidly progressive osteoarthritis of the hip . Contact pressure . Biomechanical study * Kiyokazu Fukui

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“…If a patient presenting with bilateral pain is known to have an underlying generalized bone condition, the occurrence of bilateral insufficiency fractures should be considered. A typical example, which frequently causes diagnostic difficulty, is sacral insufficiency fractures (Peh et al, 1995;Verhaegen and Sauter, 1999). These can be easily missed on plain X-ray imaging (Figure 6a) and are much more readily apparent on CT (Figure 6b).…”

Section: Insufficiency Fracturesmentioning

confidence: 99%

‘Spot the difference’: the importance of recognizing symmetrical trauma

Rutherford¹,

Sampson²

2005

Trauma

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The eye can play tricks on us and optical illusions are commonly used to illustrate the fact that the brain interprets perceived images according to what it ‘expects’ to see. When viewing trauma imaging, we tend to subconsciously use the body’s symmetry as a reference point and therefore symmetrical injuries can easily be overlooked, even when gross. In this article, we will illustrate this phenomenon with examples of imaging from trauma cases and suggest how recognition of typical patterns of injury in addition to knowledge of some common pitfalls in trauma radiology can help us avoid the misinterpretation of bilateral symmetrical abnormalities.

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Insufficiency fractures, an often unrecognized diagnosis

Cited by 13 publications

References 0 publications

Sacral Insufficiency Fractures

Sacral Insufficiency Fractures

Inversion of the acetabular labrum causes increased localized contact pressure on the femoral head: a biomechanical study

‘Spot the difference’: the importance of recognizing symmetrical trauma

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