Co-occurrence of subchondral insufficiency fracture of the femoral head and contralateral femoral neck fracture in a rheumatic patient receiving steroid treatment

Abstract

We describe a 79-year-old woman with rheumatoid arthritis who suffered from subchondral insufficiency fracture of the femoral head (SIF) and contralateral femoral neck fracture. Radiographs obtained two months after the onset of thigh pain showed collapse of the right femoral head and contralateral femoral neck fracture. MRI revealed a subchondral serpiginous low-intensity band in the right femoral head on the T2-weighted image. This case report suggests that SIF should be considered in the differential diagnoses of rheumatic patients who suffer from thigh pain without antecedent trauma.

Subchondral Insufficiency Fracture of the Femoral Head may be Associated with Hip Dysplasia: A Pilot Study

“…Therefore, we presumed the increased joint contact pressure on the anterolateral edge of the dysplastic acetabulum could produce a subchondral fracture in SIF. This presumption is consistent with case reports in which initial collapse occurred in the superolateral portion of the femoral head corresponding to the acetabular rim [13,14,23]. Furthermore, Motomura et al [14] presented a SIF case in which a patient with developmental dysplasia of the acetabulum had subchondral fractures in the femoral head and the acetabulum, suggesting an impact on the acetabular edge led to the fractures in both sides.…”

“…The fact that SIF occurs in most cases without any antecedent trauma suggests there may be underlying subchondral bone insufficiency or excessive mechanical stress on the subchondral bone. Several reports note the presence of hip dysplasia in patients with SIF [5,13,14]. This raises a question regarding whether dysplasia could contribute to SIF.…”

“…However, we still consider treatment for osteoporosis important for patients with SIF because osteoporosis is a major cause of the fractures in elderly patients [7], and numerous reports strongly support the occurrence of SIF in patients with osteoporosis [1,5,13,14,17,[20][21][22][23].…”

“…Yamamoto and Bullough [20] reported histologic findings of 10 patients with SIF in which thin disconnected bone trabeculae indicative of osteopenia were observed throughout the femoral head in all cases. Several reports of SIF include patients with dysplasia of the acetabulum [5,13,14].…”

Subchondral Insufficiency Fracture of the Femoral Head in Elderly People

“…Of them, subchondral insufficiency fracture of the femoral head (SIFFH) is caused by normal or physiological stress without antecedent trauma and usually occurs in elderly patients with poor bone quality. Since it has been reported not only in osteoporotic patients without underlying disease, but also in patients who were treated with corticosteroids for systemic lupus erythematosus and organ (kidney or liver) transplantation, most authors emphasize the importance of differentiating SIFFH from osteonecrosis (1, 2, 3, 4). SIFFH is known as a rare condition.…”