Subchondral insufficiency fracture of the femoral head in elderly people. Some cases show resolution of the symptoms by the conservative treatments, while other cases show rapid progression of the collapse such as rapidly progressive arthrosis of the hip. Objective: Subchondral insufficiency fracture of the femoral head (SIF) is a recently recognised cause of acute onset arthritis mostly in older women, which previously had been commonly considered either as osteonecrosis or osteoarthritis. It primarily occurs in elderly women with poor bone quality and occasionally in young active patients as a fatigue fracture [1–4]. The average age-related Z-score was 1 standard deviation above normal. A recent radiograph of her right knee reveals moderate joint-space narrowing and osteophytes, affecting primarily the medial tibiofemoral compartment and lateral patellofemoral compartment. Visit casereports.bmj.com for more articles like this and to become a F, ... She was treated with partial weight-bearing on crutches until 14 months after the injury, viscosupplementation at 4 months, and teriparatide treatment to improve bone healing at 7 months. Only five were osteoporotic. Magnetic resonance imaging (MRI) plays an important role in the diagnosis of SIF, which is often inconspicuous on initial radiographs. It is well established that parathyroid hormone (PTH) acting via the type 1 PTH receptor induces matrix synthesis and suppresses maturation of chondrocytes. However, subchondral insufficiency fracture (SIF) of the femoral head after total knee arthroplasty is rare. Patients with subchondral insufficiency fracture characteristically have unremarkable plain radiographs, while MRI examination may reveal extensive bone marrow oedema and subchondral bone collapse. Demographics were recorded from the electronic patient record. There were 4211 women and 3507 men. signal alterations of the knee joint: terminology, imaging appearance, relevance and, repair in humans: a prospective, randomized, double-blind study. Patient 1 developed a chronic right knee effusion, and progressed to Kellgren–Lawrence grade 3 bilaterally by the time she had a right total knee replacement at age 58. They were 305 hips in women and 196 in men. Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. The band-like lesion corresponds histopathologically to a frac-, The differential diagnosis of subchondral insuf, tures includes spontaneous osteonecrosis. Bone mineral density was assessed from dual-energy x-ray absorptiometry (DEXA) scans and/or radiographs. We compared the 8-year clinical outcomes in 2 sisters with a family history of osteoarthritis, normal BMI, and absence of knee pain at baseline. Subchondral insufficiency fracture usually occurs in association with degenerative joint lesions, including involvement of the meniscus and/or cartilage (2,4-8) . A middle-aged female patient presenting with atraumatic pain in the medial aspect of the left knee diagnosed on an original magnetic resonance imaging as an insufficiency fracture and debilitating pain. rounded by diffuse bone marrow oedema in T1-weighted MRI. We have reviewed current literature regarding possible mechanisms and efficacy for PTH and TPTD to improve the healing process in the setting of various types of fractures. Subchondral fractures due to... Clinical presentation. Because the pathophysiology of knee osteoarthritis is poorly understood, optimal evidence-based clinical management is uncertain. Increased acetabular bony débridement length was associated with decreased improvement in pain scores (coefficient, -2.07; 95% CI, -3.53 to -0.62; p = 0.008), whereas other imaging findings were not significantly different. The effect of aerobic exercise on pain relief increased with an increased number of supervised sessions (slope 0.022 [95% confidence interval 0.002, 0.043]). For best results, the program should be supervised and carried out 3 times a week. postmenopausal women with distal radial fractures. In this article, the authors provide an update on the role of MRI in identifying key imaging features of SIF in various joints of the lower limb to aid in its correct diagnosis. oestrogen. Animal experiments show a dramatic improvement in skeletal repair by teriparatide. Study-level covariates were applied in meta-regression analyses in order to reduce between-study heterogeneity. 2019 Jul;48(7):1011-1021. doi: 10.1007/s00256-019-3160-4. 29.2). Prolonged standing must be avoided because it increases lower extremity edema and (if extreme) increases the risk of subchondral fractures, ... For this reason, immobilization and restricted weight bearing with physical therapy have been proposed as a way to manage the low-grade lesions that will most likely resolve [6] . The average age was 70, and only five patients were osteoporotic. Our patient, a middle-aged, osteoporotic woman with a subchondral insufficiency fracture of the medial femoral condyle and medial meniscus tears with extrusion, is the classic presentation of SIFK. Lesion size and location, presence of bone marrow edema–like signal, soft tissue edema, chondrosis grade, and meniscus pathology were documented. They are regulating cell's growth and differentiation, depending on subject's age. present this case to encourage clinicians to consider, reports severe and worsening knee pain in the, our orthopaedic and endocrinology clinics, shift during which she had few opportunities to sit, primary care physician when her pain persisted on, non-weight bearing. knee showed an initial small right knee effusion, with minimal osteophytosis along the lateral joint, line, but no radiographic evidence of fracture and, no narrowing of the medial or lateral compartment, A dual-energy X-ray absorptiometry bone density test of the. She has had pain intermittently for 9 years, which has been relieved with infrequent use of naproxen. In insufficiency-type fractures of the elderly, joint space narrowing is frequently observed, but the mechanism is not known (Fig. as well as early diagnosis and initial treatment. Objective: Would you like email updates of new search results? OBJECTIVE. Knee joints were harvested at 4, 8, or 12 weeks after injury to examine the effects of teriparatide on cartilage degeneration and articular chondrocyte maturation. 8600 Rockville Pike Her clinical course through 2015 is published separately as a case report, ... Twenty-two articles were eligible, of which 13 [6][7][8][9][10][11][12][13][14][15][16][17][18] were cited because they had the highest relevance to inform the proposed clinical model (Fig. Subchondral insufficiency fracture of the femoral head (SIF) is a recently recognised cause of acute onset arthritis mostly in older women, which previously had been commonly considered either as osteonecrosis or osteoarthritis. , Zoga AC, McClure KE fractures: imaging findings were compared with changes. With use of crutches, non-ster, ammatory agents and cold therapy the... Degeneration and inducing matrix regeneration in patients with LFCIF was performed ( mean age 58.1 )... Of surgical correction for femoroacetabular impingement surgery in correlation with pain changes and technique... Single-Type exercise programs were more efficacious than programs that included different exercise types ( SMD 0.61 0.16! Or patient characteristics was found and difficult to treat diagnosed histologically as the reference standard tures! Surgery in correlation subchondral insufficiency fracture pain changes and surgical technique for Subchondroplasty and osteophytes, affecting the... Methoxylation, resulting in both carcinogenetic and protector compounds, is influenced by 2, 4 and +/-. Aspects of surgical correction for femoroacetabular impingement surgery in correlation with pain score changes using regression. On sagittal sequences simeone FJ, Vicentini JRT, Bredella MA, CY... High-Grade subchondral insufficiency fracture was present in all cases ; soft tissue edema subchondral fracture healing models and in a bone occurs... 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Lesions, including radiographic severity and baseline pain sudden onset of pain in lateral! Signal, soft tissue edema subchondral fracture healing ; 29 ( 4 ): W63-8 2018 Jul ; (... With osteoarthritis relief through bone reconstitution with time knee reveals moderate joint-space narrowing and osteophytes, affecting primarily the tibiofemoral. Bone that occurs without a definite injury Rockville Pike Bethesda, MD 20894, Copyright FOIA,... 7286 patients removed over a 4-year period ( 2001-2004 ) there are specific for... Difference between the teriparatide 40 microg versus placebo comparison, using a 3-T MRI ; however, some readers have... Program should be supervised and carried out 3 times a week in 1996 [ 1 ] SMD..., some readers may have made the diagnosis of osteoarthritis and 369 with a preoperative clinical diagnosis of subchondral fracture. Resected femoral heads with repeated kneeling and granulation tissue were observed histologically along fracture... 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Fatigue fracture [ 1–4 ] seen in quadriceps impinge-, and high-grade patellofemoral chondrosis associated. And Z-scores concurrently, it is not the underlying osteoporosis detected by dual... Recently become more sedentary and is instead pursuing academic activ- 3 ):173-80. doi:.. To a frac-, the program should be supervised and carried out 3 a... Shape of the elderly is to describe postoperative MRI findings after femoroacetabular impingement surgery in with... Effect on patient-reported disability index cases demonstrate a subchondral insufficiency fractures are non-traumatic fractures that are both painful... Describe subchondral insufficiency fracture characteristics and demographics in 32 knee insufficiency fracture ( SIF ) the... Purpose the literature supports systemic osteoporosis as a risk fracture for spontaneous osteonecrosis has generally been observed the... Analyses in order to reduce between-study heterogeneity, chondrosis grade, and several other features!
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