J Korean Med Sci.  2014 Apr;29(4):593-598. 10.3346/jkms.2014.29.4.593.

Subchondral Insufficiency Fracture of the Femoral Head in Elderly People

• Yoon PW
• Kwak HS
• Yoo JJ
• Yoon KS
• Kim HJ

• KMID: 1774468
• DOI: http://doi.org/10.3346/jkms.2014.29.4.593

Abstract

We evaluated the clinical course of subchondral insufficiency fracture of the femoral head (SIFFH) and its characteristic findings with special regard to joint space narrowing (JSN). Thirty-one cases of SIFFH of mean age 68.9 yr initially underwent limited weight-bearing conservative treatment. During the follow-up period, the patients with intractable pain underwent total hip arthroplasty (THA). For radiographic evaluation, lateral center-edge angle, JSN and femoral head collapse (FHC) were documented, and the extent of FHC was classified as mild (<2 mm), moderate (2-4 mm), and severe (>4 mm). The progression or new development of FHC more than 2 mm was evaluated on sequential plain radiographs. The relationship between radiographic parameters and clinical outcomes were evaluated. THAs were performed in 15 cases (48.4%). There was no significant correlation between clinical outcomes and the extent of initial FHC. However, a significantly larger proportion of patients that underwent THA showed JSN and FHC progression compared to the symptom improvement group. The risk factor significantly associated with failed conservative treatment was JSN (P=0.038; OR, 11.8; 95% CI, 1.15-122.26). Clinical results of conservative treatment for SIFFH in elderly patients are relatively poor. The patients with JSN are at higher risk of failed conservative treatment.

Keyword

Hip; Fractures; Bone; Risk Factors; Outcome Assessment (Health Care)

MeSH Terms

Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip
Body Mass Index
Disease Progression
Female
Femur Head/pathology/*radiography
Hip Fractures/pathology/*radiography
Humans
Logistic Models
Magnetic Resonance Imaging
Male
Middle Aged
Odds Ratio
Risk Factors

Figure

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  Fig. 1 The extent of femoral head collapse (the distance between A and B) was measured using concentric circles (C, the center of the femoral head).

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  Fig. 2 An anteroposterior radiograph of an 82-yr-old male patient with left hip pain showed no femoral head collapse and joint space narrowing initially (A). Radiograph made at eight weeks later shows joint space narrowing of the left hip (B).

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  Fig. 3 The initial radiograph of a 76-yr-old male patient shows joint space narrowing of the right hip joint (A). Radiograph five months later shows progression of joint space narrowing and femoral head collapse (B).

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  Fig. 4 MR images of the same patient in Fig. 3. (A) T1- and (B) T2-weighted signal intensity images show a subchondral fracture (arrows) and the bone-marrow-edema pattern extending to the subchondral area.

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  Fig. 5 Gross photograph of the resected femoral head of the same patient in Fig. 3 showed a markedly destroyed articular cartilage.

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  Fig. 6 Histology of the superior portion (dotted read rectangle) of the resected femoral head of the same patient in Fig. 3, showing fracture callus formation (arrows) and granulation tissue (H&E, ×40 [A], ×100 [B]).

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