Occult fracture of the femoral neck associated with extensive osteonecrosis of the femoral head: A case report

Fukui, Kiyokazu; Kaneuji, Ayumi; Matsumoto, Tadami

doi:10.1016/j.ijscr.2015.07.025

Cited by 6 publications

(10 citation statements)

References 25 publications

(18 reference statements)

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“…The sub-capital fractures associated to large osteonecrosis areas present a bad prognosis when they are managed with osteosynthesis, cases in which the performance of hip total arthroplasty is indicated. However, when they are associated to small necrosis lesions, the articular preservation measures, plus osteosynthesis with cannulate screws are useful, as in the case of our patient [1,2,17]. Ikemura et al showed such usefulness in the differentiation of the clinical characteristics of sub-capital fracture for insufficiency of the associated osteonecrosis, in which the risk factors play a fundamental role in such differentiation, because although most of the femoral neck fractures occurs with a latter osteonecrosis as complication, the not displaced fractures of the femoral neck, as a complication of the femoral head osteonecrosis, are very rare [17][18][19][20].…”

Section: Discussionmentioning

confidence: 88%

Pathological Fracture of Femoral Neck Associated to Femoral Head Osteonecrosis: Case Report

A¹,

E²,

Noriega³

2019

JSCR

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Introduction: The osteonecrosis of femoral head is a progressive and devastating condition for the prognosis of the coxofemoral joint, with an increase in its prevalence and an etiology of multifactorial nature, and with compromise specially in young or middle age (20 to 40 years of age) patients [1-3]. The fractures associated to femoral head osteonecrosis are very rare, being the subchondral portion the site with a higher compromise, and the junction between the necrotic bone and the bone under remodeling process another site of potential fracture [4-7]. The management of this condition can vary from a conservative management to a surgical management with total hip arthroplasty, depending on patient’s clinic and the extension of his necrotic lesion. Discussion: This patient presents a sub-capital fracture of his femoral neck, associated to osteonecrosis of the femoral head. This patient was managed with decompression of the osteonecrosis nucleus plus bone graft and osteosynthesis with cannulate screws, in order to decrease bone hypertension and avoid femoral collapse. Conclusion: Although femoral neck fractures, as a complication from femoral head osteonecrosis are rare, in our patient such association can be found due to the worsening of his painful clinical features and the absence of a previous traumatic event, which allows discarding femoral osteonecrosis as a fracture complication.

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Section: Discussionmentioning

confidence: 88%

Pathological Fracture of Femoral Neck Associated to Femoral Head Osteonecrosis: Case Report

A¹,

E²,

Noriega³

2019

JSCR

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“…We treated our case with total hip arthroplasty. Fukui [10] reported a case of occult fracture of the femoral neck due to extensive ONFH in a 60-year-old man with hip pain. Yoon [11] reported an unusual case of ONFH that was misdiagnosed as a stress fracture.…”

Section: Discussionmentioning

confidence: 99%

Avascular necrosis of the femoral head following an occult femoral neck stress fracture

Cheng

Bang

2022

VOJNOSANIT PREGL

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Introduction. Osteonecrosis of the femoral head (ONFH) is an intractable disease that causes progressive femoral head collapse, severe pain, and gait disturbance. We report a case of avascular necrosis of the femoral head following an occult femoral neck stress fracture, which shows that early diagnosis and treatment are very important. Case report. A 55-year-old woman presented to our department with a chief complaint of low back pain that radiated into the left anterolateral thigh for 2 months Her left anterolateral thigh became progressively more painful over a period of about 2 weeks. No abnormal findings indicative of ONFH or an occult fracture of the femoral neck were detected by X-ray or computed tomography (CT), but an occult insufficiency fracture of the left femoral neck was identified on magnetic resonance imaging (MRI). The diagnosis of femoral neck stress fracture was delayed, resulting in femoral head necrosis. The fracture was treated with total hip arthroplasty and the resected femoral head was subjected to histopathology. Based on the histopathological findings, the final diagnosis of this case was ONFH with an occult fracture of the left femoral neck. Clinical symptoms were relieved postoperatively. Conclusion. In patients presenting with a suspected stress fracture of the femoral neck, early MRI examination is recommended to avoid femoral head necrosis due to a delayed diagnosis.

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“…Regarding fracture terminology : There exists a diversity in description of this fracture that develops in the setting of extensive ONFH (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). A stress fracture may be defined as a complete or incomplete Table I.…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous subcapital fracture (SSF) of femoral neck complicating ONFH is an uncommon presentation and only a few cases have been reported so far (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). These reports largely present unilateral subcapital SSF of the femoral neck, with femoral head in various stages of osteonecrosis (3)(4)(5)(6)(7)(11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Spontaneous subcapital femoral neck fracture complicating osteonecrosis of femoral head

Arora¹,

Kumar²,

Khan³

et al. 2021

Acta Orthop Belg

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Spontaneous subcapital fracture (SSF) of femoral neck in pre-existent osteonecrosis of femoral head (ONFH) is a rare presentation. Only a few cases have been reported so far and majority of them have been reported to have unilateral hip involvement. We retrospectively reviewed clinical-radiological data of 10 patients (12 hips) with SSF complicating ONFH. All of them underwent uncemented total hip arthroplasty. All the available publications in the English language based medical literature were critically reviewed and results were summarized. The median age of presentation was 32 years (range : 24 years to 61 years). They were followed up for a mean duration of 25 months (range : 12 months to 59 months). The most common risk factor was corticosteroid consumption (7 out of 10 patients). All except one (modified Ficat and Arlet stage II) belonged to advanced stage of ONFH {stage III 3 patients (3 hips), stage IV 6 patients (8 hips)}. The mean time lag of ONFH to presentation was 22.3 months (range : 5 months to 60 months), and SSF to presentation was 13.8 days (range : 1 day to 28 days). Mean pre- operative Harris Hip Score was 10.8 (range : 8 to 14), which improved to 93 (range : 91 to 96) after total hip arthroplasty when last followed up (p<0.05). Corticosteroids induced ONFH has a propensity to develop SSF. This entity should find a place in existing classification system.

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Occult fracture of the femoral neck associated with extensive osteonecrosis of the femoral head: A case report

Abstract: HighlightsOsteonecrosis of the femoral head should be included in the differential diagnosis of insufficiency fracture of the femoral neck.Enhanced MRI may be useful in determining the existence of extensive osteonecrosis of the femoral head.

Cited by 6 publications

References 25 publications

Pathological Fracture of Femoral Neck Associated to Femoral Head Osteonecrosis: Case Report

Pathological Fracture of Femoral Neck Associated to Femoral Head Osteonecrosis: Case Report

Avascular necrosis of the femoral head following an occult femoral neck stress fracture

Spontaneous subcapital femoral neck fracture complicating osteonecrosis of femoral head

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