Abstract
A subchondral insufficiency fracture of the femoral head (SIF) is generally observed
in elderly women. In addition, SIF has been reported to occur in young military trainees,
which are considered to be due to a fatigue stress fracture. This report reviewed
five cases of SIF in young adults without any history of overexertion or antecedent
trauma. The clinical findings, time to the initial radiograph, time to the initial
magnetic resonance imaging (MRI), and follow-up period were investigated. Radiographs
and MRI were obtained in both hips. Bone mineral density and bone scintigram were
performed. Measurements of a bone mineral density indicated presence of osteopenia
in three patients. MRI disclosed a discontinuous irregular-shaped low-intensity band
surrounded by bone marrow edema in all cases. After conservative treatments, one patient's
condition resolved, while four patients underwent femoral head collapse resulting
in surgical treatment. In these four patients, the diagnosis of SIF was histologically
confirmed. In addition, the histological findings showed thin disconnected bone trabeculae,
thus indicating the presence of some degree of osteopenia. These patients were considered
to demonstrate an insufficiency fracture rather than a fatigue stress fracture based
on both clinical findings and histological findings. SIF needs to be considered in
patients presenting with hip pain even in young cases.
Keywords
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Article info
Publication history
Published online: June 25, 2010
Accepted:
May 21,
2010
Received:
April 1,
2010
Footnotes
☆This work is supported in part by a research grant for Intractable Diseases from the Ministry of Health and Welfare of Japan, a Grant-in-aid for Scientific Research (No. 21591948) from the Japan Society for the Promotion of Science, and a grant from the Takeda Science Foundation.
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Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
