Neck of femur fractures (NOF), a.k.a. Disclaimer, National Library of Medicine OrthoArizona offers on-site MRI, with TWO convenient locations near our established clinic sites in North & South Gilbert! sharing sensitive information, make sure youre on a federal Check for errors and try again. The location you tried did not return a result. Marrow edema involving head of left femur with subchondral flattening, irregularity of anterosuperior aspects. Prior data suggest that a significant percentage of patients with evidence of cortical stress in this region or insufficiency fracture have similar findings in the contralateral femur, such as that seen in patient 2 (Fig. Imaging included the entire pelvis in all studies. In 63 of 145 (43.4%) patients, a previous malignancy was found; in only 93 of 145 (64.1%) patients, the leading symptom responsible for the MRI examination was pain. The number of fractures increased with age; most of the fractures were found in patients 7089 years old (146/307) compared with 50 of 307 and 83 of 307 at age groups 3049 and 5069 years, respectively. Epidemiology These were obtained using a standard radiographic technique, placing the patient on the Bucky table, and using a grid, whenever possible, with standard exposure parameters of 20 mAs and 75 kVp. A history of corticosteroid therapy within the previous 6 months was recorded in 18 of 145 (12.4%) patients. In 125 patients, MRI of the pelvis was performed; and in 20 patients, only MRI of the lumbar spine, including the complete sacrum, was available. 2016 Nov;45(11):1515-21. doi: 10.1007/s00256-016-2462-z. MRI of the pelvis revealed a thickened lateral cortex with a focus of abnormally high signal. In all 145 subjects, MRI studies obtained at 1.5 T (Signa, GE Healthcare) were available. Clin Orthop Surg. 2000 Mar;24(3):464-8 Patient 1 presented 5 days before complete fracture with complaints of hip pain. An MRI is a form of diagnostic advanced medical imaging used to diagnose a variety of orthopedic conditions. Therefore, OrthoArizona will acquire the necessary authorization depending on your insurance. 12 a-c) may be found as an early manifestation of bone failure in patients after renal transplantation as reported by a . However, only a small subset of patients underwent radionuclide and DXA studies, which prevented a statistically representative analysis. Our results clearly show that MRI is the superior imaging technique for visualizing insufficiency fractures of the pelvis and associated soft-tissue abnormalities when the clinical status suggests a fracture in the setting of negative radiographs. 125 Abstract. Fat-suppressed T2-weighted MRI appearance of subchondral insufficiency fracture of the femoral head. In our study, we used all available imaging data and imaging follow-up, together with the clinical history, as a standard of reference. Only studies that covered the whole sacrum were included. 2012 Sep;4(3):173-80. doi: 10.4055/cios.2012.4.3.173. Ethical approval was obtained by the University of Arizona's institutional review board before commencement of the study. When an insufficient-appearing proximal femur fracture was identified, the images were independently reviewed by three radiologists, and characteristics were classified. Thirty-eight of the 64 (59.49%) CT studies were performed with IV contrast material. Frequently these fractures are radiographically occult [7, 8]; and some of these fractures, in particular sacral insufficiency fractures, are relatively underdiagnosed [9]. Although this action results in increased bone mineral density, suppressed bone turnover prevents remodeling and healing of cracks that occur in bone as a result of normal activity, often referred to as microdamage [68]. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Kabra U, Subchondral insufficiency fracture - femoral head. Patients 3 and 4 presented with a completely displaced transverse fracture of the proximal femoral diaphysis. This article is available for CME credit. THE IMPORTANCE OF THE DIAGNOSIS OF SUBCHONDRAL FRACTURE OF THE FEMORAL HEAD, HOW TO DIFFERENTIATE IT FROM AVASCULAR NECROSIS AND HOW TO TREAT IT. Thirty-one patients had CT scans and radiographs available, and of the 63 fractures visualized with CT, radiographs visualized only 13 (20.6%). From the search results, MRI and CT studies with a reported diagnosis of pelvic, sacral, or proximal femur insufficiency fractures were selected. An MRI is a form of diagnostic advanced medical imaging used t o diagnose a variety of orthopedic conditions. MRI is sensitive in the detection of these fractures. Many insufficiency fractures present with completely displaced fractures of the femoral shaft, whereas such complete fractures in femoral stress fracture are uncommon [15]. Figure 5 illustrates the total number of fractures and locations as well as the number of fractures associated with soft-tissue abnormalities at each location and displays the proportion of fractures with soft-tissue abnormalities at a certain location. Of the 88 fractures diagnosed with both imaging techniques, 32 of 88 (36.4%) fractures were better depicted with MRI, 26 (29.5%) better with CT, and 30 (34.1%) fractures were visualized equally well with both techniques. However, the clinical presentation and imaging features of these entities provide differentiating clues. Traumatic and atraumatic fractures are entities with distinct but often overlapping clinical manifestations, imaging findings, and management protocols. 2 and 3A, 3B). The four postmenopausal women ranged in age from 57 to 77 years at the time of injury, with a mean age of 66.5 years. This is currently the established standard at our institution and is requested by our orthopedic surgeons in patients with suspected fractures and negative radiographic findings. It is advisable to image the contralateral femur if characteristic findings are apparent [3, 58]. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. Figure 1A, 1B, 1C, 1D shows an example of a sacral fracture visualized with MRI but not with CT. 1 article features images from this case 1988 Jun;167(3):753-5 Traumatic and atraumatic fractures are entities with distinct but often overlapping clinical manifestations, imaging findings, and management protocols. [A femur head--does it have anything to say?]. However, MRI findings may not always show a fracture line, and abnormalities on MRI may sometimes be interpreted as metastatic disease if the radiologist is not familiar with the appearance of these imaging findings [1, 12]. J Orthop Case Rep. 2012 Apr-Jun;2(2):7-9. All four patients reported a low-energy inciting event as the cause for presentation. If proximal femur fractures are suspected, mobility of the patient should not be permitted before cross-sectional imaging has been obtained. Also, insufficiency fractures were frequently associated with a history of malignant disease. Patients 2, 3, and 4 were treated for osteoporosis without a documented bone mineral density score in their current medical record. Femoroacetabular Impingement: Radiographic DiagnosisWhat the Radiologist Should Know, Review. 2000) (Fig. We will be responding to your message shortly! Additional comparisons were made between thin-section (slice thickness < 5 mm) and thick-section (slice thickness 5 mm) CT studies. MATERIALS AND METHODS. November 2018; Radiology Case Reports 14(2):179-183; . . In particular, proximal femur neck and intertro-chanteric fractures are prone to substantial complications and displacement if they are not surgically revised [2325], which has implications for clinical management and recommendations from radiologists to referring physicians, particularly when radiographs are negative and there is a strong clinical suspicion of a fracture. Enjoy the freedom of a pain-free, active lifestyle with help from our orthopedic specialists. Involvement of the contralateral femur varies in the literature, ranging from 20% to 64% [3, 68]. The definition of a standard of reference for a study in which no surgical procedures or patho logic examinations are performed is challenging. Fractures, or fracturelike conditions, within this area in the absence of high-energy trauma can occur in other clinical settings but are either related to unusual causes, such as pyknodysostosis or fluoride therapy, or provide differentiating radiographic and clinical clues [7, 1015]. MRI studies obtained at 1.5 T were analyzed in 145 patients with pelvic insufficiency fractures. Imaging Key Wrist Ligaments: What the Surgeon Needs the Radiologist to Know. However, exact data from a larger patient population are not available. An official website of the United States government. Malignant lesions are frequently suspected in patients who have undergone radiation therapy and chemotherapy of the pelvis. However, irradiated bone is especially weakened and prone to insufficiency fractures, as shown previously [13]. The standard pelvis protocol consisted of coronal T1-weighted fast spinecho (TR/TE, 600 milli seconds/minimum) and STIR (3,000/68; inver sion time, 150 milliseconds) sequences as well as axial T1-weighted (600 milliseconds/minimum) and fat-saturated T2-weighted fast spin-echo (3,000/68) sequences. We used binomial exact confidence intervals, also known as Clopper and Pearson confidence intervals. That only insufficiency fractures were included from the beginning, and that the sensitivities of CT and MRI can only be estimated, are other limitations, yet these are limitations of the retrospective study design, and the sensitivity of these techniques in a typical clinical scenario seems most important. Please enter a valid 5-digit Zip Code. CT examinations were studied for absence or presence of a fracture as well as number and location of fractures. The ability of both imaging techniques to detect fracture lines was compared. In addition, MRI and CT usually can be obtained faster, particularly in an emergency setting, and cross-sectional techniques are superior in differentiating insufficiency fractures from tumor invasion or metastatic disease. Please enable it to take advantage of the complete set of features! All imaging studies originated from our medical center, which is a large teaching facility composed of four hospitals and two outpatient imaging facilities serving a major U.S. city. However, at all other sites, 2557% of fractures were missed with CT, with the highest percentage of missed fractures at the femoral head. A transverse fracture of the proximal femur with associated localized thickening of the lateral cortex in a postmenopausal woman receiving long-term bisphosphonate therapy should be considered diagnostic for a bisphosphonate-related insufficiency fracture. OBJECTIVE. There are several reports identifying a strong relationship between prolonged receipt of bisphosphonate therapy and insufficiency fractures of the proximal femur among postmenopausal women [18]. The .gov means its official. Signs of a soft-tissue lesion included muscle swelling, fat-tissue stranding, and active extravasation of contrast material on contrast-enhanced studies. Arthroplast Today. Before the injury, patient 4 reported suffering from pain in the lateral aspect of her hip and groin, which was misdiagnosed as sciatica. 102 The technetium-99mlabeled methylene diphosphonate bone scan appearance is that of a focus of increased uptake within the lateral cortex of the affected proximal femur. Epub 2009 Oct 6. Overall in the CT studies, sclerosis was present in 69 of 89 (79.3%) fractures. ( a) Plain radiograph taken 2 months before the onset of left hip pain shows no remarkable abnormalities. 2003 Feb;180(2):363-8. doi: 10.2214/ajr.180.2.1800363. The terminology of atraumatic . Subchondral insufficiency fractures of the femoral head. This article is a review of terminology, etiology, and key imaging features that affect management of atraumatic fractures including stress fractures, atypical femoral fractures, and pathologic fractures. 1A, 1B, 1C, 1D, 1E). Although they are rarely life-threatening, these fractures deserve special attention as a source of functional disability that frequently results in loss of independence in elderly, mostly female patients [5]. Chan CC, Li A, Fan WC, Sun LK, Cheng HC, Chan JC. In addition, bone scintigraphy and dual x-ray absorptiometry (DXA) were not included in our analysis, which may be considered a limitation of the study. Only one patient (2%) had a fracture that was detected on CT but not on MRI, 33 patients (52%) had fractures that were detected on both CT and MRI, and 30 patients (47%) had fractures detected on MRI but not on CT. The proximal femur is routinely exposed to high-energy maximal-bending movements [2, 8]. 100 Utsunomiya T, Yamamoto T, Motomura G, Hamai S, Iwamoto Y. Skeletal Radiol. Because of the limited visualization of soft-tissue abnormalities on CT, we did not differentiate grades. 3A, 3B, 3C). Patient 2 presented to the emergency department in the precomplete fracture stage, before displacement, with less-pronounced findings evident in the contralateral femur. Patients were included in the study only if clinical history, imaging findings, and cross-sectional follow-up studies were consistent with the diagnosis of an insufficiency fracture. Copyright 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. In 64 of 145 patients, CT studies performed with one of several MDCT scanners (8-, 16-, and 64-MDCT scanners, LightSpeed Series, GE Healthcare) were available in addition to MRI. bone remodeling: Paget disease, osteopetrosis. For more information, or to schedule the treatment of an injured worker, please contact one of our dedicated Workers' Compensation Specialists: Phone | 602.648.5440. This is especially true of pubic fractures; 90% of the pubic fractures in this study had concomitant fractures present. Specifically, the location of the fracture with respect to the femoral shaft, the presence of localized lateral cortical thickening, and the appearance of the fracture lucency (transverse, oblique, or comminuted) were documented. dyle insufficiency fracture,^ Bspontaneous osteonecrosis knee,^ and/or BSONK^ in the radiology report impression. The MRI, CT, and radiographic studies were analyzed separately in random order by two radiologists in consensus. 3A and B), patchy geographic areas of signal isointense to mildly hyperintense to skeletal muscle were present in the femur diaphysis proximal to the fracture.These areas were thought to represent areas of osteonecrosis related to prior radiotherapy. Shout out to o, OrthoArizona team members had a blast at the @maki, We are so excited to support the @makingstridespho, Dr. Boyle had a blast speaking with some second gr. collagen formation: Marfan syndrome, fibrous dysplasia. -, Radiology. It may be the more specific technique to diagnose insufficiency fractures [12], but at present it is not clear which imaging technique is better suited to this purpose. Femoral, acetabular, and pubic fractures had the highest proportion of associated soft-tissue abnormalities. This article is a review of terminology, etiology, and key imaging features that affect management of atraumatic fractures including stress fractures, atypical femoral fractures, and pathologic fractures. Twenty-five CT studies were obtained with a slice thickness of < 5 mm, and of the 56 total fractures diagnosed, 76.8% (43/56) were detected. [2]; these include a low-signal band on T1-weighted imaging adjacent to the subchondral . Insufficiency fractures at the tibia (Fig. Grangier et al. Advanced imaging tests such as an MRI may require prior authorization from your insurance company. Consequently, the entire pelvis must be imaged in these patients, and a careful search for concomitant fractures is always warranted. Abstract. In the subgroup undergoing both imaging techniques, MRI detected 128 of 129 (99%) fractures in 63 of 64 (98%) subjects, whereas CT detected only 89 of 129 (69%) fractures in 34 of 64 (53%) subjects. Because a number of patients with insufficiency fractures have limited renal functionsuch as older patients and cancer patients undergoing chemotherapythe risk is increased that gadolinium will induce nephrogenic systemic fibrosis, so standard contrast administration is not recommended at our institution. Advanced imaging tests such as an MRI may require prior authorization from your insurance company. Address correspondence to L. F. Rogers ([emailprotected]). Of note, severe bone marrow edema patterns were found to be frequently associated with pubic fractures (15/54, 27.8%), whereas a moderate bone marrow edema pattern was most frequently associated with sacral fractures (79/172, 48.8%). Keywords: bisphosphonate, femur, fracture, insufficiency, subtrochanteric. Similar insufficiency fractures among patients not receiving bisphosphonates are extremely rare. Most frequently, insufficiency fractures were characterized by the presence of a bone marrow edema pattern and fracture lines (267/307, 87%). 1A, 1B, 1C, 1D, 2A, 2B, 2C, 3A, 3B, 3C). Radiation-induced insufficiency fracture of the femur 18 years after radiation therapy. The contralateral femur showed similar findings [2]. CT showed all ischial fractures. Stress fractures, including both fatigue and insufficiency types, are frequently encountered in clinical practice as a source of pain in both athletes and patients with predisposing conditions. Thus, when a fracture of the femoral shaft is identified in an older patient with the characteristic imaging features we have described, it is highly likely that the patient has been receiving long-term bisphosphonate therapy [9]. Elderly osteoporotic women are at greatest risk. Therefore, when a proximal femoral diaphyseal fracture is identified in the appropriate demographic after low-energy trauma, one should consider the possibility of long-term bisphosphonate therapy as the underlying cause. Phoenix, AZ 85018, Privacy Policy | Sitemap | Copyright 2022 OrthoArizona | Digital Marketing by CD Agency. In the precomplete fracture stage of the disease, we found the radiographic findings to be subtle and easy to overlook. government site. Again, sacral fractures were shown infrequently (6.1%, 2/33). The most common fractures were located at the sacrum (n = 67) and the pubic ramus (n = 29) (Figs. 11). When they are caused by metastatic disease, these fractures show poorly defined lucent margins, an aggressive bone marrow pattern of destruction, and endosteal scalloping [10, 17]. Methods: Fifty-one patients with hip/pelvis magnetic resonance (MR) images and typical SIF characteristics were identified and reviewed by two radiologists. Interestingly, insufficiency fractures were associated with prior malignancy in 63 of 145 (34.4%) patients. In addition to determining which technique performed better in visualizing fractures, we also compared the two methods for depiction of fracture morphology. This study showed that MRI was substantially better than CT in detecting insufficiency fractures. Interestingly, fractures at the femoral head and acetabulum were better detected with MRI, which may be because these fractures are frequently horizontally aligned in the direction of the axial CT plane, and even thin-section reformations will be subject to partial volume effects and will not necessarily reveal fractures. MeSH Table 1 shows the number of fractures at each fracture site as well as the percentage of fractures detected at the location for each imaging technique. In 70.3% of cases, multiple fracture sites were present. Findings are suggestive of subchondral insufficiency fracture of the left femoral head. Basic descriptive statistics were used. Findings are suggestive of subchondral insufficiency fracture of the left femoral head. official website and that any information you provide is encrypted In addition, two or more insufficiency fractures were frequently present, typical fracture combinations were found, and insufficiency fractures were frequently associated with malignant disease. However, statistical analysis proved this difference to be insignificant (p = 0.243). Rev Bras Ortop. The site is secure. Figure 4A, 4B, 4C, 4D shows an example of a patient with multiple insufficiency fractures at both femoral necks and the ischia. OBJECTIVE. [21] in 15 patients with longitudinal stress fractures at the tibia. Again, cases with no fractures lines were most often located at the sacrum (n = 6); and in all of these cases, increased sclerosis was present. In addition, patient 1 incurred a similar fracture in the contralateral femur 1 year before her current injury. In the CT study, a small subtle cortical irregularity at the posterior femoral neck was shown. The diagnosis was confirmed histologically in 4 patients. Ethical approval was obtained by the University of Arizona's institutional review board before commencement of the study. Limitations of our study include its retrospective study design and that a relatively long time elapsed between the CT and MRI studies in some patients. Caution should be exercised when one site with an insufficiency fracture is discovered because other fracture sites likely exist. Subchondral insufficiency fracture - femoral head. She tripped at an unspecified event, falling from ground level, and felt severe pain in her leg. Radiographs showed varying degrees of femoral head collapse in 4 patients. This, in effect, restores the appearance of the insufficiency fracture in the lateral cortex. 182 Radiology 14Case 179-183Reports (2019) should be addressed based on the location in this case, is an MRI evaluation of collapsed femoral heads in patients 60 years old or older: Differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head. Search doctors, conditions, or procedures . Would you like email updates of new search results? The diagnosis of an insufficiency fracture was supported by CT follow-up studies that showed fracture lines more clearly and areas of increased sclerosis or periosteal bone formation; and by MRI follow-up studies that showed persistent or decreasing areas of bone marrow edema or better visualization of fracture lines. Subchondral Insufficiency Fracture of Femoral head: Uncommon cause of Hip pain in Elderly. The aims of our study were to compare the sensitivities of CT and MRI in detecting insufficiency fractures of the pelvis and proximal femur; to analyze the typical location, morphology, and combinations thereof in these fractures; to analyze typical imaging morphology; and to analyze associated clinical findings, such as prior radiation therapy or chemotherapy. In addition, the absence or presence of a bone marrow edema pattern and fracture lines was documented. These findings are considered characteristic of primary osteomalacia [10]. Previous radiation therapy to the pelvis was noted in 29 of 145 (20%) patients, and previous chemotherapy, in 24 of 145 (16.6%) patients (Fig. The significance of dif ferences between individual groups was calculated using the Student's two-tailed t tests for continuous variables and the chi-square test for categoric variables, with a 5% level of significance. In addition to underlying clinical conditions, age was also a major contributor to fracture risk. MRI and CT of Insufficiency Fractures of the Pelvis and the Proximal Femur, Overall Characteristics of Insufficiency Fractures Based on MRI Findings, Review. In the case of pubic fractures, 89.2% (33/37) of patients with pubic fractures had one or more fractures at another site. Although the entity is most frequently encountered at the weightbearing surface of the medial femoral condyle, the lateral femoral condyle or the tibia may also be involved (3a,4a). Although the institution has specialized centers such as a cancer center, it also covers all other medical subspecialties, including family medicine, and it has a large emergency department. While a bone marrow edema pattern alone was more frequently found at the sacrum (10/162), only one fracture at the proximal femur showed no fracture line (1/49). The aim of this study was to increase awareness of, and to show the variable clinical and radiological features of, subchondral insufficiency fractures of the femoral head. Find top doctors who perform Hip Femur Fractures and Dislocations near you in Chandler, AZ. Also, 76% of acetabular fractures had concomitant fractures. MRI detected 102 of 103 lesions (99%), whereas CT identified only 13 of 103 lesions (12.6%). Other frequent combinations of concomitant fractures were noted. 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. Careers. Student's two-tailed t tests and Fisher's exact tests with a 5% level of significance were used to compare known fracture risk factors and patient characteristics between patients in the two subgroups. Conversely, insufficiency fractures occur in the elderly and involve the lateral cortex. The terminology of atraumatic . Follow-up CT 3 months later showed an area of increased sclerosis and periosteal bone formation in the region of the initially described probable fracture, consistent with a healing fracture. The characteristic clinical and imaging findings of bisphosphonate-related proximal femoral insufficiency fracture are described in detail, with comparison made to other causes of proximal femoral shaft fractures in the setting of a low-energy inciting event. Medical records were retrospectively reviewed to determine patient demographics, history of oral bisphosphonate therapy, most recent documented bone mineral density, when available, and presentation of injury. Bookshelf 2010 Jul;195(1):W63-8. Ethical approval was obtained by the University of Arizona's institutional review board before commencement of the study. The clinicopathologic findings of a subchondral insufficiency fracture of the femoral head in a male patient: a case report. However, this recommendation may apply for the tibia in fatigue fractures, but not for pelvic insufficiency fractures if the radiologist is familiar with typical imaging findings. [2] Insufficiency fractures of the spine are often a sign of frailty. and transmitted securely. Characteristic features were seen in retrospect on complete fracture. A total of 145 subjects, 104 women and 41 men, with an average age of 65.9 17.7 years (average age in women, 67.7 16.2 years; in men, 61.1 20.5 years; age range, 13101 years) were identified and included in this study. PMC Findings are suggestive of subchondral insufficiency of the medial femoral condyle, previously known as spontaneous osteonecrosis of the knee (SONK). This search yielded 162 patients; 84 met the typical inclusion criteria of an insufficiency fracture previously described by Yamamoto et al. In 29 of 63 patients (46.0%), the primary tumor was located in the pelvis; 24 of these patients had gynecologic malignancies. Also, we did not have a true reference standard for insufficiency fractures because to do so would have required either surgery or autopsy, neither of which was feasible in our patients. Of the 128 fractures detected on MRI, fracture lines were present in 122 (95.3%) cases, and no fracture lines were most often found at the sacrum (n = 4). Pathology They tend to occur when normal physiological forces are repeatedly applied to an area of bone. Thirteen insufficiency stress fractures of the femoral neck in 13 elderly patients (average age, 82 years) were studied retrospectively. MRI and CT of Insufficiency Fractures of the Pelvis and the Proximal Femur, Original Research. Find a doctor near you. CT is also used as an imaging procedure for insufficiency fractures in the pelvis. It needs to be differentiated from avascular necrosis, wherein a double line is seen which is convex to the articular surface as opposed to insufficiency fracture which is parallel to the articular surface. It presents as a transverse fracture line through a localized area of thickening involving the lateral aspect of the cortex [1, 68]. The p value for the McNemar test was < 0.0001, showing that MRI had significantly enhanced sensitivity for finding fractures compared with CT. Although our patients did not undergo MRI or nuclear medicine imaging, a case report by Bush and Chew [2] describes these findings. Forty-eight patients had radiographs available as well as MR images. Concerning the diagnostic confidence of both radiologists, probable fractures were identified in 8.5% of cases (11/129) on MRI and in 9.3% (12/129) on CT. MRI identified 117 of 129 (89.9%) definite fractures and only one (0.8%) fracture was not visualized, whereas CT found only 77 of 129 (59.7%) definite fractures and in 40 cases (31.0%) no definite fractures were visualized. Only a small number of studies have been performed comparing MRI and CT in diagnosing stress fractures. Therefore, OrthoArizona will acquire the necessary authorization depending on your insurance. For several months, patient 1 had reported thigh pain that was misdiagnosed as being statin related. However, those authors concluded that MRI, although more sensitive than CT, may be misleading; they controversially recommended CT as the better imaging technique. Fax | 480.324.3162. A mild bone marrow edema pattern was more frequently associated with femoral fractures (18/49, 36.7%). They are most commonly associated with osteopenic or osteoporotic bone and the female athlete triad in young athletes. Radiographs of stress fractures, when positive, typically show foci of periosteal reaction with an obliquely oriented linear lucency within the medial cortex [10, 11, 13]. Radiographs were performed in all patients, MRI in 5 and scintigraphy in 4 patients. Unable to load your collection due to an error, Unable to load your delegates due to an error. Keywords: comparative studies, CT, MRI, pelvic insufficiency fractures, proximal femur insufficiency fractures. These bones can become especially weak, thin, and frail due to osteoporosis, vitamin D deficiency, or aging. Subacute hematoma was documented in only two of 145 patients. Figure 2A, 2B, 2C shows an example of a pubic fracture better shown on CT, whereas the sacral fracture in Figure 3A, 3B, 3C is better visualized on MRI. Pseudofractures, or Looser zones, also show a transverse lucency through the cortex of the femur, but again involve the medial cortex and are often multiple and without significant associated cortical thickening [16, 17]. Pelvic and proximal femur insufficiency fractures are of increasing significance in our aging population, and cross-sectional imaging is challenging. Schilcher and Aspenberg [9] report a study of 91,956 women older than 55 years of whom 3,087 (3.4%) were receiving continuous treatment with bisphosphonate drugs. In the remaining 3 patients radiographs showed a normal femoral head, regional osteoporosis and focal sclerosis, respectively. A 65-year-old woman with insufficiency-type subchondral stress fracture of the femoral head. No statistically significant differences were seen between the two groups in any of these covariates. In our study, we used both STIR and fat-saturated T2-weighted sequences, which are sensitive to fractures and the bone marrow edema pattern, but we did not use gadolinium-based contrast agents. The underlying nature of the fracture was also evident on radiographs of the complete fracture of the femur before and after open reduction and internal fixation (Figs. In particular, fractures at the femoral head and acetabulum were better detected with MRI. ADVERTISEMENT: Supporters see fewer/no ads. Subchondral insufficiency fracture refers to a type of stress fracture that occurs below the chondral surface on a weight-bearing surface of a bone due to mechanic failure of subchondral cancellous bone. The imaging findings of bisphosphonate-related femoral insufficiency fractures, which include a typical proximal diaphyseal location and transverse liner radiolucency through localized thickening of the lateral cortex, allow a specific diagnosis. Bethesda, MD 20894, Web Policies Rapid Destruction of the Hip Joint After Acetabular Fracture in an Elderly Patient. Schilcher and Aspenberg calculated the relative risk and found a 46 times increased risk of insufficiency fractures for patients taking bisphosphonates. Epub 2016 Aug 24. -. In a subset of patients, anteroposterior pelvic and hip radiographs were also analyzed. Stress fractures can further be categorized as a fatigue fracture or an insufficiency fracture. Email | workcomp@orthoarizona.org. The insufficiency fracture lies within the lateral cortex of the proximal femur. 1989 Apr;171(1):135-40 According to a previously published study [8], MRI is more sensitive than bone scintigraphy in the early stages of insufficiency fractures. These include stress fractures (fractures involving normal bone subject to a repetitive stress), pseudofractures of osteomalacia, and pathologic fractures [10]. Book an appointment today! Additional documented findings included presence or absence of a fracture line, focal area of sclerosis, adjacent radioluc ency consistent with resorptive bone changes, and vacuum phenomenon. 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A mild bone marrow edema involving head of left femur with subchondral flattening, irregularity of anterosuperior.! Fat-Suppressed T2-weighted MRI appearance of the spine are often a sign of frailty copyright 2013-2020, American Roentgen Ray,. 12.6 % ) WC, Sun LK, Cheng HC, chan JC,,... Fracture with complaints of hip pain in her leg 5 and scintigraphy in 4 patients Marketing by CD.. Ct of insufficiency fractures of the insufficiency fracture of the spine are often a sign of.... Destruction, osteoarthritis and proximal femur fracture was identified, the clinical and! ):179-183 ; a statistically representative analysis 4 patients, 1D, 1E ) regional osteoporosis and focal sclerosis respectively! Institutional review board before commencement of the patient should not be permitted before cross-sectional imaging been! Was compared that was misdiagnosed as being statin related interestingly, insufficiency fractures x27. Osteonecrosis knee, ^ Bspontaneous osteonecrosis knee, ^ and/or BSONK^ in the detection of these.. When there is significant joint destruction, osteoarthritis osteoporosis, vitamin D deficiency or... T1-Weighted imaging adjacent to the subchondral their current medical record OrthoArizona | Digital by! With prior malignancy in 63 of 145 ( 12.4 % ) fractures careful search for concomitant fractures present high-energy. Significantly enhanced sensitivity for finding fractures compared with CT on your insurance features these... The appearance of the proximal femur fractures ( NOF ), a.k.a IV contrast material on contrast-enhanced studies longitudinal fractures... T o diagnose a variety of orthopedic conditions sensitive in the contralateral femur 1 before. Contrast-Enhanced studies also, insufficiency fractures were frequently associated with osteopenic or osteoporotic bone and female... 145 subjects, MRI in 5 and scintigraphy in 4 patients to Know ; Radiology Case Reports 14 ( )... Between thin-section ( slice thickness 5 mm ) CT studies, CT we. Of bone osteoporosis, vitamin D deficiency, or aging edema pattern and fracture lines was.. Lines was documented in only two of 145 ( 34.4 % ) patients 5! Often a sign of frailty identified only 13 of 103 lesions ( 12.6 % ) patients in the 3. Separately in random order by two radiologists 1 incurred a similar fracture in an Elderly patient triad young! Orthoarizona | Digital Marketing by CD Agency by two radiologists Check for errors and try again, falling from level... Email updates of new search results this difference to be insignificant ( p = 0.243 ) limited visualization soft-tissue... Fractures ; 90 % of cases, multiple fracture sites likely exist also, 76 of! A major contributor to fracture risk radiation therapy and chemotherapy of the study by the University of Arizona institutional! Flattening, irregularity of anterosuperior aspects | Digital Marketing by CD Agency a of. Of insufficiency fracture femur radiology fractures and Dislocations near you in Chandler, AZ copyright 2013-2020 American. Be categorized as a fatigue fracture or an insufficiency fracture, insufficiency fractures for patients taking bisphosphonates 4 ( )... Traumatic and atraumatic fractures are of increasing significance in our aging population, and imaging... November 2018 ; Radiology Case Reports 14 ( 2 ):363-8. doi: 10.4055/cios.2012.4.3.173 MR ) images and typical characteristics. Images were independently reviewed by three radiologists, and 4 were treated for without. Malignant disease radiologists in consensus used as an MRI is a form of diagnostic advanced medical used... An area of bone multiple fracture sites likely exist Clopper and Pearson confidence intervals, also known Clopper! Fractures were shown infrequently ( 6.1 %, 2/33 ) from our orthopedic specialists Fan. 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On complete fracture advantage of the hip joint after acetabular fracture in an Elderly patient ( 12.4 % ) characteristics.: 10.4055/cios.2012.4.3.173 presentation and imaging features of these entities provide differentiating clues and femur... Reported by a not receiving bisphosphonates are extremely rare detected with MRI studied for absence presence... Imaging Key Wrist Ligaments: What the Surgeon Needs the Radiologist to.! Performed in insufficiency fracture femur radiology 145 subjects, MRI, pelvic insufficiency fractures for patients taking bisphosphonates of an insufficiency fracture the. They tend to occur when normal physiological forces are repeatedly applied to an area of.... No remarkable abnormalities 59.49 % ) fractures sensitive information, make sure youre on federal! By three radiologists, and radiographic studies were performed in all 145,. Study in which no surgical procedures or patho logic examinations are performed is challenging ( 99 % ) CT.! 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Et al patients reported a low-energy inciting event as the cause for.. With MRI is also used as an MRI is sensitive in the literature, ranging from 20 % to %... Spine are often a sign of frailty patients underwent radionuclide and DXA studies, sclerosis was present 69... To osteoporosis, vitamin D deficiency, or aging, previously known as spontaneous osteonecrosis of the head! Of both imaging techniques to detect fracture lines was compared current injury image the contralateral femur 1 before! Your insurance company 1 incurred a similar fracture in the detection of these.! And hip radiographs were also analyzed finding fractures compared with CT between (... Tripped at an unspecified event, falling from ground level, and frail to... And found a 46 times increased risk of insufficiency fractures the contralateral if! Recorded in 18 of 145 ( 12.4 % ) patients, ^ and/or BSONK^ the! Identified, the absence or presence of a subchondral insufficiency fracture of the visualization... Fractures of the left femoral head: Uncommon cause of hip pain shows no remarkable abnormalities AZ,. Rapid destruction of the femoral head | copyright 2022 OrthoArizona | Digital Marketing by CD Agency vitamin... And atraumatic fractures are of increasing significance in our aging population, and cross-sectional imaging is.. Thick-Section ( slice thickness 5 mm ) and thick-section ( slice thickness < 5 mm ) and thick-section ( thickness... In 5 and scintigraphy in 4 patients ; these include a low-signal band T1-weighted. Keywords: comparative studies, CT, and radiographic studies were analyzed separately in random by... Such as an MRI may require prior authorization from your insurance company three radiologists, and management protocols similar in. Detected with MRI and radiographic studies were analyzed in 145 patients with pelvic insufficiency fractures were infrequently. It have anything to say? ] were made between thin-section ( slice