Unusual Osteonecrosis of the Femoral Head Misdiagnosed as a Stress Fracture

Yoon, Taek Rim; Rowe, Sung Man; Song, Eun Kyoo; Mulyadi, Dicky

doi:10.1097/00005131-200401000-00009

Cited by 8 publications

(8 citation statements)

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“…Other authors report about the successful use of pinhole bone scans. Nevertheless, numbers available are still low and there is no real evidence about the specificity of this technique and therefore it should be evaluated in larger series before it can be recommended as generally necessary in the diagnostic algorithm of stress fractures in adolescent [1,8,24,31].…”

Section: Symptoms and Diagnosismentioning

confidence: 99%

Stress Fractures in the Juvenile Skeletal System

et al. 2005

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Stress fractures affecting the juvenile skeletal system are rare and are described as having a good prognosis. Precisely because these fractures are so rare, studies allowing clear and generally applicable conclusions are lacking. The object of the present study was a systematic analysis of patients with stress fractures in an immature skeletal system, with special reference to the frequently difficult and delayed diagnosis and to the forms of therapy considered appropriate. Twenty-five patients with a total of 27 stress fractures affecting bones with the growth plates still open were examined according to a standardized procedure. The average duration of follow-up was 4.8 years (SD +/- 2.3) and the average age at occurrence 12.9 years (SD +/- 4.31). The risk factors were largely the same as those in adults. The most frequent site was the tibia (48% of cases; n = 13), followed by the metatarsal bones. Most (26/27) fractures were treated conservatively, with an average duration of therapy of 8.9 weeks (SD 8.2 weeks). Ultimately, 17 (63%) of the fractures healed in such a way as to allow the patients to return to full athletic activity with no restrictions within 3 months after diagnosis. In 9 cases (33%) it was not possible to achieve complete absence of symptoms within 12 months after diagnosis was made. No pseudarthroses were observed. There was a significant correlation between clinical outcome recorded as "free of symptoms" and an early diagnosis (less than 2 weeks after first symptoms (p = 0.033) and a fracture line seen on MR tomography in contrast to a stress reaction with merely increased signal intensity (p = 0.037). Overall, a strikingly high proportion of these patients had a prolonged course. This is attributable partly to the delay in diagnosis and to inappropriate initial treatment. When stress fractures were recognizable by a demonstrable fracture line--in contrast to just an edema--on MR tomography and their diagnosis was followed by an adequate form of therapy the chances of complete healing seemed to be better. It is essential to carry out targeted imaging investigations, e.g., by means of MR tomography, when there is a reason to consider a stress reaction. Furthermore, stress fractures should be adequately treated until all symptoms have disappeared.

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Section: Symptoms and Diagnosismentioning

confidence: 99%

Stress Fractures in the Juvenile Skeletal System

et al. 2005

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“…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. However, in our patient, the delayed diagnosis of femoral neck stress fracture resulted in femoral head necrosis.…”

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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“…Subcapital pathologic fracture can occur because of extensive ONFH if there is no history of trauma. There have been some reports of subcapital fractures caused by extensive ONFH [21–24] .…”

Section: Discussionmentioning

confidence: 99%