Subchondral Insufficiency Fracture of the Femoral Head in Elderly People

Yoon, Pil Whan; Kwak, Hong Suk; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

doi:10.3346/jkms.2014.29.4.593

Cited by 25 publications

(19 citation statements)

References 20 publications

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“…However, the use of this definition of progression has the benefit of being easily defined and confirmed, and it is generally quite indicative of disease severity; this definition has been used in previous literature in large multi-centre trials as a marker for degenerative joint disease progression [4,20,[29][30][31]. To further validate the use of this definition of progression, we compared our results of this analysis with those using radiographic definitions of progression, and these have confirmed our significant findings regarding the imaging characteristics associated with worse prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Previously thought to be a disease predominantly affecting elderly patients, SIF have since been reported in adults of varying ages and activity levels [2][3][4]. Though subchondral fractures do not necessarily comprise a separate disease process, SIF have been identified as a separate entity from osteonecrosis and trauma-related subchondral fractures through histopathologic evaluation [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Subchondral insufficiency fractures of the femoral head: associated imaging findings and predictors of clinical progression

et al. 2015

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Objectives To characterize the morphology and imaging findings of femoral head subchondral insufficiency fractures (SIF), and to investigate clinical outcomes in relation to imaging findings. Methods Fifty-one patients with hip/pelvis magnetic resonance (MR) images and typical SIF characteristics were identified and reviewed by two radiologists. Thirty-five patients had follow-up documentation allowing assessment of clinical outcome. Subgroup comparisons were performed using regression models adjusted for age and body mass index. Results SIF were frequently associated with cartilage loss (35/ 47, 74.5 %), effusion (33/42, 78.6 %), synovitis (29/44, 66 %), and bone marrow oedema pattern (BMEP) (average crosssectional area 885.7±730.2 mm 2 ). Total hip arthroplasty (THA) was required in 16/35 patients, at an average of 6 months post-MRI. Compared to the THA cohort, the non-THA group had significantly (p<0.05) smaller overlying cartilage defect size (10 mm vs. 29 mm), smaller band length ratio and fracture diameters, and greater incidence of parallel fracture morphology (p<0.05). Male gender and increased age were significantly associated with progression, p<0.05.Conclusions SIF were associated with synovitis, cartilage loss, effusion, and BMEP. Male gender and increased age had a significant association with progression to THA, as did band length ratio, fracture diameter, cartilage defect size, and fracture deformity/morphology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Subchondral insufficiency fractures of the femoral head: associated imaging findings and predictors of clinical progression

et al. 2015

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“…While the history and patient age may help differentiate ON from a subchondral insufficiency fracture, from a practical standpoint, both conditions are likely to progress to degenerative arthritis best managed by a hip arthroplasty. An insufficiency fracture is seldom amenable to nonsurgical treatment, and patients with joint space narrowing are at higher risk of failing nonoperative treatment [56].…”

Section: Subchondral Insufficiency Fracturementioning

confidence: 99%

Osteonecrosis of the femoral head: diagnosis and classification systems

Choi

Steinberg

Cheng

2015

Curr Rev Musculoskelet Med

103

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Osteonecrosis of femoral head is a rare but disabling condition that usually results in progressive femoral head collapse and secondary arthritis necessitating total hip arthroplasty if not treated appropriately in early stages. However, early diagnosis is challenging as the onset of disease is insidious and the symptoms and signs are usually minimal and nonspecific until it becomes advanced. Of several diagnostic modalities, magnetic resonance imaging (MRI) is considered the imaging method of choice with the highest sensitivity and specificity, while detection of potential risk factors is very important as well. Many investigators have developed several different classification systems; however, there still is controversy regarding the optimal classification system. Diagnostic methods and the evolution of different classification systems will be reviewed in this paper.

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“…In this study, six hips without a sclerotic boundary were classified as Stage 1, 10 hips with a sclerotic boundary as Stage 2, and 35 hips with both a sclerotic boundary and minimal collapse (femoral head collapse <2 mm) as Stage 3. Based on both anteroposterior and lateral radiographs obtained at the same time that CT was performed, we measured the extent of collapse in each patient with Stage 3 hips, as previously described . Briefly, the extent of femoral head collapse was measured based on both anteroposterior and lateral radiographs as the distance between an estimated circle that was fit to each femoral head and the maximum incursion into the femoral head on the line passing through the center of the femoral head (Fig.…”

Section: Methodsmentioning

confidence: 99%