Insufficiency subchondral fracture of the femoral head: Report of 4 cases and review of the literature

Buttaro, Martín; Valle, Alejandro González Della; Morandi, Ana; Sabas, M.; Pietrani, Marcelo; Piccaluga, Francisco

doi:10.1054/arth.2003.50092

Cited by 38 publications

(14 citation statements)

References 9 publications

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“…Hip and thigh pain were her chief complaints, accompanied by intermittent sharp hip pain. As noted by others, our patient also demonstrated significant abnormal hip ROM, 4,5,6,7 an antalgic gait, 4,6,7,12,26,28,30,34,53,63 palpatory tenderness, 6,7,36,63 and night pain. 5,21,26,30,45 There is no literature demonstrating the clinical accuracy of the sign of the buttock, although it has been stated in other case studies 26 and is commonly used by physical therapists.…”

Section: Outcomesupporting

confidence: 86%

Differential Diagnosis of a Femoral Neck/Head Stress Fracture

Gurney

Boissonnault²,

Andrews³

2006

J Orthop Sports Phys Ther

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Study Design: Resident's case problem. Background: Identifying stress fractures of the hip can be a challenging differential diagnosis. Pain presentation is not always predictable and radiographs may not show the fracture, especially during its early stages. Hip stress fractures left untreated can displace and necessitate open reduction internal fixation or total hip arthroplasty. Diagnosis: A 70-year-old woman presented to the physical therapy clinic with complaints of right hip pain. She had been evaluated by a physician and radiographs of the hip, which revealed some arthritic changes, were otherwise normal. Upon examination, the physical therapist observed an antalgic gait, a noncapsular pattern of limitation of hip motion, an empty painful end feel at the end range of motion (ROM) for hip abduction, external rotation, and flexion, and extreme tenderness to palpation over the anterior hip region. The therapist suspected a more pernicious problem than osteoarthritis and discussed his suspicion with the physician. The physician subsequently requested an MRI that revealed a femoral neck and head stress fracture that was later confirmed with a bone scan. The patient was provided with a walker for ambulation with a non-weight-bearing status for 6 weeks, after which she returned to physical therapy for progressive weight bearing and strengthening. She was discharged with a relatively pain-free hip and was ambulating with a cane. A 2-month follow-up examination revealed a pain-free hip and a return to all premorbid activities, including ambulation without an assistive device. Discussion: The presence of a normal radiograph of the hip should not be considered conclusive in ruling out a stress fracture in the hip region. The current case demonstrates how careful evaluation can reveal occult pathologies and prevent potentially catastrophic morbidity. J Orthop Sports Phys Ther 2006;36:80-88.

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Section: Outcomesupporting

confidence: 86%

Differential Diagnosis of a Femoral Neck/Head Stress Fracture

Gurney

Boissonnault²,

Andrews³

2006

J Orthop Sports Phys Ther

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“…Because of the rare incidence of SIFFH, most of the reported cases have been case reports or small series reports (1, 2, 3, 4, 5, 9, 15, 16, 17). Of these limited number of cases, many were reported to be treated by THA.…”

Section: Discussionmentioning

confidence: 99%

“…All patients had failed initial conservative therapy and they eventually undergone THA between 2 and 13 months from the onset of hip pain. Buttaro et al (5) reported four cases of SIFFH. All cases showed progressive femoral head collapse and three of them were treated with THA after 4-12 months of conservative treatment.…”

Section: Discussionmentioning

confidence: 99%

“…SIFFH is known as a rare condition. But the number of cases of SIFFH in the literature is increasing on the basis of characteristic findings from magnetic resonance image (MRI) such as subchondral fractures and bone marrow edema patterns which are distinct from those of osteonecrosis (5, 6, 7, 8, 9). However, most cases were reported as case reports and the number of case series studies is very limited.…”

Section: Introductionmentioning

confidence: 99%

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Subchondral Insufficiency Fracture of the Femoral Head in Elderly People

et al. 2014

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We evaluated the clinical course of subchondral insufficiency fracture of the femoral head (SIFFH) and its characteristic findings with special regard to joint space narrowing (JSN). Thirty-one cases of SIFFH of mean age 68.9 yr initially underwent limited weight-bearing conservative treatment. During the follow-up period, the patients with intractable pain underwent total hip arthroplasty (THA). For radiographic evaluation, lateral center-edge angle, JSN and femoral head collapse (FHC) were documented, and the extent of FHC was classified as mild (<2 mm), moderate (2-4 mm), and severe (>4 mm). The progression or new development of FHC more than 2 mm was evaluated on sequential plain radiographs. The relationship between radiographic parameters and clinical outcomes were evaluated. THAs were performed in 15 cases (48.4%). There was no significant correlation between clinical outcomes and the extent of initial FHC. However, a significantly larger proportion of patients that underwent THA showed JSN and FHC progression compared to the symptom improvement group. The risk factor significantly associated with failed conservative treatment was JSN (P=0.038; OR, 11.8; 95% CI, 1.15-122.26). Clinical results of conservative treatment for SIFFH in elderly patients are relatively poor. The patients with JSN are at higher risk of failed conservative treatment.Graphical Abstract

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“…Most cases have occurred as an insufficiency stress fracture in elderly, osteoporotic people or recipients of renal transplants. [2][3][4][5][6][7] Visuri 8 suggested that it can occur as a fatigue stress fracture in young, healthy people and I am currently preparing a manuscript describing seven cases of SSFFH which occurred as a fatigue stress fracture in military recruits. SSFFH heals without collapse simply by avoidance of weight-bearing if it is detected early.…”

Section: Younge MD Frcs (C)mentioning

confidence: 99%

Friction burns within the tibia during reaming

Frölke¹,

Brouwer²

2004

The Journal of Bone and Joint Surgery. British volume

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We welcome letters to the Editor concerning articles which have recently been published. Such letters will be subject to the usual stages of selection and editing; where appropriate the authors of the original article will be offered the opportunity to reply.Letters should normally be under 300 words in length, double-spaced throughout, signed by all authors and fully referenced. The edited version will be returned for approval before publication.

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Insufficiency subchondral fracture of the femoral head: Report of 4 cases and review of the literature

Cited by 38 publications

References 9 publications

Differential Diagnosis of a Femoral Neck/Head Stress Fracture

Differential Diagnosis of a Femoral Neck/Head Stress Fracture

Subchondral Insufficiency Fracture of the Femoral Head in Elderly People

Friction burns within the tibia during reaming

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