insufficiency fracture femur radiology

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We will be responding to your message shortly! Call 602.922.9100 to schedule an appointment! Find top doctors who perform Hip Femur Fractures and Dislocations near you in Chandler, AZ. In addition to the better visualization of fractures, MRI was also more sensitive than CT in detecting soft-tissue abnormalities, as has also been shown by Feydy et al. 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. location this Summer 2022, conveniently located in the Phoenix/Scottsdale region. This article is available for CME credit. Caution should be exercised when one site with an insufficiency fracture is discovered because other fracture sites likely exist. 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. 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. Involvement of the contralateral femur varies in the literature, ranging from 20% to 64% [3, 68]. Patient 1 presented 5 days before complete fracture with complaints of hip pain. Enjoy the freedom of a pain-free, active lifestyle with help from our orthopedic specialists. For several months, patient 1 had reported thigh pain that was misdiagnosed as being statin related. Fax | 480.324.3162. The p value for the McNemar test was < 0.0001, showing that MRI had significantly enhanced sensitivity for finding fractures compared with CT. All occurred in Caucasian women with severe osteoporosis. Insufficiency fractures occur in abnormal bonethat is, bone commonly affected by generalized osteoporosisas a result of normal activity such as walking. Scintigraphy showed increased uptake in the femoral head. 102 Fractures related to Paget disease show one or more fracture lucencies projecting through the cortex along the convex margin of the femur; however, concomitant deformity of the femoral shaft is also present [10]. Of the 108 fractures diagnosed with MRI, radiography visualized only 16 (14.8%). Polesello G, Sakai DS, Ono NK, Honda EK, Guimaraes RP, Jnior WR. Fracture lines were better shown on T1-weighted sequences, and proximal femur fracture lines were best shown on sequences obtained in a coronal orientation. Slice thickness was 4 mm; matrix size, 192 192 mm; and field of view, 3236 cm. Table 2 lists locations of all 307 fractures found in the 145 patients. In the remaining 3 patients radiographs showed a normal femoral head, regional osteoporosis and focal sclerosis, respectively. Subchondral insufficiency fractures of the hip have been identified as a cause of accelerated osteoarthritis . 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. 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. This, in effect, restores the appearance of the insufficiency fracture in the lateral cortex. The amount and intensity of soft-tissue edema were also graded higher in patients with pubic, acetabular, and femur fractures versus sacral fractures. Subchondral insufficiency fracture of the femoral head. Fifty-seven of the 64 patients had at least one soft-tissue lesion, for a total of 103 lesions. With CT, a similar percentage of fracture lines was shown (78/89, 89.7%). Arthroplast Today. PMC Thirteen insufficiency stress fractures of the femoral neck in 13 elderly patients (average age, 82 years) were studied retrospectively. Methods: Fifty-one patients with hip/pelvis magnetic resonance (MR) images and typical SIF characteristics were identified and reviewed by two radiologists. Please enable it to take advantage of the complete set of features! A history of corticosteroid therapy within the previous 6 months was recorded in 18 of 145 (12.4%) patients. The sacrum (n = 13), pubis (n = 12), and femur (n = 11) were sites of 36 of the 37 fractures that occurred with acetabular fractures. However, the clinical presentation and imaging features of these entities provide differentiating clues. CT is also used as an imaging procedure for insufficiency fractures in the pelvis. Sensitivities were calculated as the percentage of patients identified by each technique based on this standard of reference, and confidence intervals were provided. Subchondral Insufficiency Fracture of Femoral head: Uncommon cause of Hip pain in Elderly. The pelvis protocol covered the proximal femur at least down to the lesser tro chanter and was used also for suspected hip fractures. -, Radiology. Radiographs showed varying degrees of femoral head collapse in 4 patients. Using clinical history, all available imaging studies, and cross-sectional follow-up studies as a standard of reference, MRI identified 128 of 129 fractures (99.2%) in 63 of 64 patients (sensitivity, 98% [95% CI, 94100%]), whereas CT alone detected only 89 of 129 fractures (69%) in 34 of 64 patients (sensitivity, 53% [3964%]). Keywords: bisphosphonate, femur, fracture, insufficiency, subtrochanteric. Address correspondence to T. M. Link ([emailprotected]). Although the exact mechanism for bisphosphonate-related insufficiency fracture of the proximal femur is not yet entirely understood, a relationship is evident [4, 5, 9]. A third MRI location will be opening at our Arcadia (44th St. & Thomas Rd.) All studies were performed with 120 kVp and milliampere values ranging from 150 to 300 mA. Please enter a valid 5-digit Zip Code. MRI has greatly improved our ability If proximal femur fractures are suspected, mobility of the patient should not be permitted before cross-sectional imaging has been obtained. MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Review. Epub 2012 Aug 14. 2000 Mar;24(3):464-8 Grangier et al. The https:// ensures that you are connecting to the 2016 Nov;45(11):1515-21. doi: 10.1007/s00256-016-2462-z. sharing sensitive information, make sure youre on a federal [A femur head--does it have anything to say?]. 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. We used binomial exact confidence intervals, also known as Clopper and Pearson confidence intervals. MRI is the superior technique compared with CT and should be the imaging technique of choice in patients with suspected insufficiency fractures. Figure 4A, 4B, 4C, 4D shows an example of a patient with multiple insufficiency fractures at both femoral necks and the ischia. Alternatively, insufficiency fractures typically present as focal cortical thickening with a transverse lucency within the lateral cortex. The site is secure. Interestingly, insufficiency fractures were associated with prior malignancy in 63 of 145 (34.4%) patients. 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. For each of the two imaging techniques, confidence of fracture diagnosis was graded on a scale of 13, where 1 represented a definite fracture; 2, a probable fracture; and 3, no definite fracture. The fracture missed on MRI was diagnosed in a 78-year-old woman who underwent 2.5-mm-slice-thickness CT 1 day previously that showed a probable fracture. From January through October 2009, we searched for cases of transverse fractures involving the proximal femur in postmenopausal women with the previously reported characteristic radiographic appearance suggestive of insufficiency injury related to long-term bisphosphonate . The anteroposterior radiograph of the affected hip acquired on initial presentation included the proximal femoral shaft; however, the insufficiency fracture was overlooked. Careers. Epub 2016 Aug 2. Pathologic fractures of the proximal femoral diaphysis are nearly always transverse and typically are due to metastatic disease, Paget disease, or fractures through preexisting Looser zones. Lateral femoral condyle insufficiency fractures: imaging findings, demographics, and analysis of outcomes LFCIFs are associated with meniscus tears, high-grade chondrosis, and osteopenia/osteoporosis with more global knee pathology present when compared with medial femoral condyle insufficiency fracture. -, Gerontology. Other frequent combinations of concomitant fractures were noted. 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. Most frequently, insufficiency fractures were characterized by the presence of a bone marrow edema pattern and fracture lines (267/307, 87%). In addition, two or more insufficiency fractures were frequently present, typical fracture combinations were found, and insufficiency fractures were frequently associated with malignant disease. Ann Pathol. Radiation-induced insufficiency fracture of the femur 18 years after radiation therapy. MRI is sensitive in the detection of these fractures. LIST YOUR PRACTICE ; Dentist ; Pharmacy ; Search . -. 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. 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). You can use Radiopaedia cases in a variety of ways to help you learn and teach. Gilbert, AZ 85297, 2940 E. Banner Gateway Dr., Ste. OBJECTIVE. 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. Subchondral insufficiency fractures are a relatively common cause of knee pain, particularly in older patients. Given the large number of referring physicians from different subspecialties, the referral pattern for this study was therefore broad and may also be representative of other institutions. Basic descriptive statistics were used. A fracture line was defined as a linear structure visualized on either STIR, T1-weighted, or fat-saturated T2-weighted fast spin-echo sequences. However, because of the limited metabolic activity of bone in these patients, imaging features of fractures are expected to persist over a period of several months, as has been shown by previous studies [17, 18]. Stevens K, Tao C, Lee SU, Salem N, Vandevenne J, Cheng C, Neumann G, Valentin-Opran A, Lang P. AJR Am J Roentgenol. [19] examined stress fractures at the tibia in 42 athletes and found a higher sensitivity for MRI than for CT (88% vs 42%) in diagnosing stress injuries. These bones can become especially weak, thin, and frail due to osteoporosis, vitamin D deficiency, or aging. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. HHS Vulnerability Disclosure, Help These fractures are treated with a trochanteric-entry nail, either one or two proximal lag screws, and distal interlocking screw fixation. Despite the cost of MRI and CT, it is important to quickly diagnose and treat these fractures. All four patients reported a low-energy inciting event as the cause for presentation. However, at all other sites, 2557% of fractures were missed with CT, with the highest percentage of missed fractures at the femoral head. 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. 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. 1A, 1B, 1C, 1D, 2A, 2B, 2C, 3A, 3B, 3C). Less frequently, in up to 25 %, insufficiency fractures at the femoral shaft can occur, predominately in elderly patients with osteoporosis (Martin-Hunyadi et al. THE IMPORTANCE OF THE DIAGNOSIS OF SUBCHONDRAL FRACTURE OF THE FEMORAL HEAD, HOW TO DIFFERENTIATE IT FROM AVASCULAR NECROSIS AND HOW TO TREAT IT. 1988 Jun;167(3):753-5 A bone marrow edema pattern was classified as severe if signal intensity on STIR or fat-saturated T2-weighted fast spin-echo images was similar to that of spinal fluid or urine in the bladder, as mild if the bone marrow edema pattern was visualized only along the fracture line (within 5 mm diameter) but not in the periphery, and as moderate if the bone marrow edema pattern was visualized > 5 mm around the fracture line or had a diameter of > 10 mm if no fracture line was present and signal intensity was less than that of spinal fluid and urine. Increased awareness of this condition will hopefully lead to earlier diagnosis and a successful outcome of conservative treatment. Findings are suggestive of subchondral insufficiency fracture of the left femoral head. In 21 of 307 cases (6.8%), only fracture lines were shown; and in 19 of 307 (6.2%) cases, only a bone marrow edema pattern was found. However, statistical analysis proved this difference to be insignificant (p = 0.243). Magnetic resonance imaging showed a low-signal band on T1- and T2-weighted images in the subchondral bone adjacent or parallel to the articular surface associated with bone marrow oedema. 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. Neck of femur fractures (NOF), a.k.a. It presents as a transverse fracture line through a localized area of thickening involving the lateral aspect of the cortex [1, 68]. 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]. Thus, a better understanding of insufficiency fractures of the pelvis is required, and further study is needed to determine whether CT or MRI is better suited to investigate these fractures. Upon stepping off a scale at her clinician's office, she heard a pop followed by weakness and eventually fell to the ground. Epub 2016 Aug 24. Diagnosis of Proximal Femoral Insufficiency Fractures in Patients Receiving Bisphosphonate Therapy, Original Research. . The insufficiency fracture lies within the lateral cortex of the proximal femur. Subacute hematoma was documented in only two of 145 patients. These findings are considered characteristic of primary osteomalacia [10]. As shown by the results of this study, MRI detected significantly (p < 0.01) more pelvic insufficiency fractures than CT. [3] compared MRI and CT findings in nine patients with insufficiency fractures of the sacrum and acetabular roof and found that three fractures were missed on CT. Those authors also recommended MRI as the best diagnostic test, comparing it not only with CT but also with bone scintigraphy and radiography. Bone marrow edema pattern was also graded in all fractures in which it was present. MRI detected 102 of 103 lesions (99%), whereas CT identified only 13 of 103 lesions (12.6%). Radiography is the imaging modality of choice for baseline diagnosis. These include stress fractures (fractures involving normal bone subject to a repetitive stress), pseudofractures of osteomalacia, and pathologic fractures [10]. A 65-year-old woman with insufficiency-type subchondral stress fracture of the femoral head. However, comparison with our study is limited because those investigators examined fatigue fractures, which have different bone mass and quality. [20] reported six patients with osteoporotic sacral insufficiency fractures; although all six were visualized with MRI, only five were shown with CT. Those authors recommended gadolinium-enhanced MRI to better differentiate insufficiency fracture from malignant disease and to exclude intraosseous tumor formation. 1989 Apr;171(1):135-40 Patient 2 stated that she suffered from non-remitting left thigh pain that was worst during ambulation for 1 month before presentation to the emergency department. 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. official website and that any information you provide is encrypted Unsuspected insufficiency fracture of the femoral head can lead to significant and rapid loss of bone stock in osteoporotic patients waiting for arthroplasty for osteoarthritis. doi: 10.1016/j.annpat.2009.07.051. 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. 1987;33(5):302-6 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. Insufficiency fractures at the tibia (Fig. Skeletal Radiol. Additional comparisons were made between thin-section (slice thickness < 5 mm) and thick-section (slice thickness 5 mm) CT studies. 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. A noncontrast magnetic resonance imaging (MRI) of the right femur was performed in conjunction with the CT ().On T1-weighted sequences (Figs. The sensitivities of CT and MRI were compared using a paired proportion test (the McNemar test). Femoral, acetabular, and pubic fractures had the highest proportion of associated soft-tissue abnormalities. A mild bone marrow edema pattern was more frequently associated with femoral fractures (18/49, 36.7%). Comparisons were also drawn between MRI and CT in the ability to detect soft-tissue abnormalities. 8600 Rockville Pike Gaeta et al. Traumatic and atraumatic fractures are entities with distinct but often overlapping clinical manifestations, imaging findings, and management protocols. Also, 76% of acetabular fractures had concomitant fractures. In nine of 63 patients (14.3%), hematologic malignancies were recorded, and in six (9.5%) breast cancer was diagnosed. 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]. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. However, only a small subset of patients underwent radionuclide and DXA studies, which prevented a statistically representative analysis. The contralateral femur showed similar findings [2]. 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. Gilbert, AZ 85234, 3033 N. 44th St. Ste. However, exact data from a larger patient population are not available. 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. Before 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. Stress fractures occur in young military recruits and athletes and involve the medial cortex when in the proximal femur [1015]. 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. An MRI is a form of diagnostic advanced medical imaging used to diagnose a variety of orthopedic conditions. To identify patients with pelvic insufficiency fractures, the radiology information system of our department was searched using the terms pelvis, sacrum or femur, and stress fractures or insufficiency fractures, for the time period from January 1, 1997, through June 27, 2007. The diagnosis was delayed in most cases because the . In addition to determining which technique performed better in visualizing fractures, we also compared the two methods for depiction of fracture morphology. collagen formation: Marfan syndrome, fibrous dysplasia. Traumatic and atraumatic fractures are entities with distinct but often overlapping clinical manifestations, imaging findings, and management protocols. 180 Radiology Case Reports 14 (2019) 179-183. MATERIALS AND METHODS. 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]. This is especially true of pubic fractures; 90% of the pubic fractures in this study had concomitant fractures present. Subchondral insufficiency fractures of the femoral head. The clinical and radiological findings in 7 patients with subchondral insufficiency fractures of the femoral head were reviewed retrospectively. 2021 Sep 4;11:122-126. doi: 10.1016/j.artd.2021.08.004. In 29 of 63 patients (46.0%), the primary tumor was located in the pelvis; 24 of these patients had gynecologic malignancies. Abstract. Forty-eight patients had radiographs available as well as MR images. Insufficiency fractures of the pelvis and proximal femur are usually found in elderly subjects and are the result of normal stress placed on abnormal bone that may be a complication of osteoporosis or previous radiation therapy but can also be the result of rheumatoid arthritis, prolonged corticosteroid therapy, renal failure, and mechanical changes after hip surgery [15]. The appearance of the fracture mimics that of a tibial striation, or stress fracture, seen in the anterior cortex of the tibia. This area of the proximal femur is susceptible to stress fracture because of the origin of the vastus medialis and insertion of the adductor brevis [11]. 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. Find a doctor near you. In the precomplete fracture stage of the disease, we found the radiographic findings to be subtle and easy to overlook. Ethical approval was obtained by the University of Arizona's institutional review board before commencement of the study. 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. The amount and intensity of soft-tissue edema give additional information on the extent of injury and may have clinical implications relating to the degree of pain and disability as well as indicating the prognosis of an insufficiency fracture. The limitation of that study was that thin-slice MDCT with multiplanar reformations was not available at the time the study was performed; only 4- to 8-mm axial images with sagittal reconstructions were available. Their presence is sometimes unexpected and can lead to incorrect diagnoses and many unnecessary, costly diagnostic procedures [10]. The standard of reference we usedlongitudinal imaging, clinical follow-up, and all other available imaging studies over several yearsis the best available alternative. Copyright 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. 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. In the case of pubic fractures, 89.2% (33/37) of patients with pubic fractures had one or more fractures at another site. Slice thickness was 4 mm; matrix size, 256 192 mm; and field of view, 1624 cm. We present a case of subchondral insufficiency fracture diagnosed radiographically and confirmed by histology that progressed to rapid hip destruction over a 1-month period. Forty percent of the 25 patients with femoral fractures had concomitant fractures. From January through October 2009, we searched for cases of transverse fractures involving the proximal femur in postmenopausal women with the previously reported characteristic radiographic appearance suggestive of insufficiency injury related to long-term bisphosphonate therapy. In only 93 of 145 (64.1%) patients, the chief symptom leading to the MRI examination was pain. Pathology They tend to occur when normal physiological forces are repeatedly applied to an area of bone. However, consideration should be given to the implications of a missed diagnosis that may misdirect or delay treatment. The Rotator Interval: A Review of Anatomy, Function, and Normal and Abnormal MRI Appearance, Pictorial Essay. In 102 of 145 patients (70.3%) more than one fracture was found. government site. From the search results, MRI and CT studies with a reported diagnosis of pelvic, sacral, or proximal femur insufficiency fractures were selected. 1E). The imaging characteristics of bisphosphonate-related insufficiency fractures that we describe are, in our experience, unique and easily recognized by a trained observer. The sites most commonly associated with pubic fractures were the sacrum and the acetabulum, with 40 (70.1%) and nine (15.8%) concomitant fractures, respectively. The rationale for this cutoff value was the altered bone metabolism in patients with insufficiency fractures that also induced delayed fracture healing, with a healing period of at least several months [17, 18]. MRI and CT of Insufficiency Fractures of the Pelvis and the Proximal Femur, Original Research. Because of the limited visualization of soft-tissue abnormalities on CT, we did not differentiate grades. Email | [email protected]. Although our patients did not undergo MRI or nuclear medicine imaging, a case report by Bush and Chew [2] describes these findings. Only a small number of studies have been performed comparing MRI and CT in diagnosing stress fractures. Imaging Key Wrist Ligaments: What the Surgeon Needs the Radiologist to Know. Thank you for contacting our Performance Team! Staatz et al. -, Am J Surg Pathol. The ability of both imaging techniques to detect fracture lines was compared. In the CT study, a small subtle cortical irregularity at the posterior femoral neck was shown. Findings are suggestive of subchondral insufficiency fracture of the left femoral head. In all 145 subjects, MRI studies obtained at 1.5 T (Signa, GE Healthcare) were available. In the 20 patients in whom only lumbar spine MRI was performed, sagittal and axial T1-weighted (TR range/TE, 500600 milliseconds/minimum) and fat-saturated T2-weighted fast spin-echo (TR range/TE range, 3,5004,000/6090) sequences as well as a coronal T1-weighted fast spin-echo (500 milliseconds/minimum) sequences were obtained. Medical records confirmed prolonged (> 3 years) oral bisphosphonate use of various agents in four patients with findings suggestive of insufficiency fracture related to long-term bisphosphonate therapy. 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Fractures, or fracturelike conditions, within the proximal femoral diaphysis seen in the setting of low-energy trauma do occur in other clinical situations. Rapid Destruction of the Hip Joint After Acetabular Fracture in an Elderly Patient. Figure 1A, 1B, 1C, 1D shows an example of a sacral fracture visualized with MRI but not with CT. 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. 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. Again, sacral fractures were shown infrequently (6.1%, 2/33). Therefore, awareness of this disorder is especially important for the radiologist, particularly in the setting of existing malignant disease, to avoid misinterpretation as bone metastases. 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. This site needs JavaScript to work properly. Patients 3 and 4 presented with a completely displaced transverse fracture of the proximal femoral diaphysis. 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. The most recent lumbar spine bone mineral density T score for patient 1, acquired over 1 year before fracture, was 2. 182 Radiology 14Case 179-183Reports (2019) should be addressed based on the location in this case, is an femoral neck fractures, are common injuries sustained by older patients who are both more likely to have unsteadiness of gait and reduced bone mineral density, predisposing to fracture. Delayed diagnosis can lead to immobility and complications such as deep vein thrombosis, loss of strength, decreased cardiac output, depression, and increased bone resorption and calcium excretion [11]. 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. Ethical approval was obtained by the University of Arizona's institutional review board before commencement of the study. Keywords: comparative studies, CT, MRI, pelvic insufficiency fractures, proximal femur insufficiency fractures. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Kabra U, Subchondral insufficiency fracture - femoral head. Unsuspected insufficiency fracture of the femoral head can lead to significant and rapid loss of bone stock in osteoporotic patients waiting for arthroplasty for osteoarthritis. Fractures averaged 2.1 per patient (range, 16 fractures per patient). CT showed all ischial fractures. In our study, we used all available imaging data and imaging follow-up, together with the clinical history, as a standard of reference. Twenty-five patients were diagnosed with acetabular fractures, and in 19 (76%) of these patients concomitant fractures were present. 100 125 2012 Sep;4(3):173-80. doi: 10.4055/cios.2012.4.3.173. The diagnosis was confirmed histologically in 4 patients. Atypical femoral fractures (AFF) are stress or 'insufficiency' fractures, often complicated by the use of bisphosphonates or other bone turnover inhibitors. An MRI is a form of diagnostic advanced medical imaging used t o diagnose a variety of orthopedic conditions. Case Discussion. Accessibility To date, to our knowledge, there is only one report in the radiologic literature describing these fractures [2]. The proximal femur is routinely exposed to high-energy maximal-bending movements [2, 8]. 1 article features images from this case Patients with metastatic disease to the pelvic bones; a history of other bone marrow disease such as myelody-splastic syndrome or Gaucher's disease; and metabolic diseases other than osteoporosis, osteomalacia and renal osteodystrophy, as well as osteomyelitis, were excluded. Announcement for Patients Regarding COVID-19, o diagnose a variety of orthopedic conditions, We are so happy when we can make our patients' day, Get to know our newest Foot & Ankle surgeon, Dr. B, Shout out to our Director of Sports Performance, @, You can tell our offices take Halloween VERY serio, Happy Halloween from OrthoArizona! Rev Bras Ortop. Case Report Ankle Ligaments on MRI: Appearance of Normal and Injured Ligaments, Superior Labral Anteroposterior Tear: Classification and Diagnosis on MRI and MR Arthrography, Review. All patients underwent MRI and were assessed for the absence or presence of a fracture as well as number and location of fractures. Imaging studies were analyzed by two radiologists; combined clinical history, findings from all imaging studies, and follow-up imaging studies served as the standard of reference. Characteristic features were seen in retrospect on complete fracture. This study showed that MRI was substantially better than CT in detecting insufficiency fractures. Femoroacetabular Impingement: Radiographic DiagnosisWhat the Radiologist Should Know, Review. As a criterion for the comparison between CT and MRI, we restricted analysis to studies obtained within 3 months of the first cross-sectional study that showed the fracture. It seems a paradox that a fracture would be associated with bisphosphonate therapy because bisphosphonates are prescribed for generalized osteoporosis to increase bone mineral density and decrease the chance of fracture. 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]. 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. Pelvic and proximal femur insufficiency fractures are of increasing significance in our aging population, and cross-sectional imaging is challenging. In particular, fractures at the femoral head and acetabulum were better detected with MRI. In a subset of patients, anteroposterior pelvic and hip radiographs were also analyzed. Means and SDs were calculated for continuous variables, and frequency and proportion for categoric variables. Patients 2, 3, and 4 were treated for osteoporosis without a documented bone mineral density score in their current medical record. An official website of the United States government. An insufficiency fracture refers to normal physiologic stress applied to bone . Femoroacetabular Impingement: Radiographic DiagnosisWhat the Radiologist Should Know. [2]; these include a low-signal band on T1-weighted imaging adjacent to the subchondral . Conversely, insufficiency fractures occur in the elderly and involve the lateral cortex. This information, in conjunction with the radiologic findings, can lead to a correct diagnosis. In addition, patients 1 and 3 switched to ibandronate sodium and risedronate, respectively, before fracture. These individuals may present after minor trauma or have symptoms of chronic lower back, pelvic, or groin pain that may appear unrelated to trauma [6]. Disclaimer, National Library of Medicine Many insufficiency fractures present with completely displaced fractures of the femoral shaft, whereas such complete fractures in femoral stress fracture are uncommon [15]. [22] argued that CT was better because of cost, diagnostic rate, and ease of fracture line visualization. The purpose of this article is to describe the imaging features of proximal femoral insufficiency fractures in patients on long-term bisphosphonate therapy. However, those authors concluded that MRI, although more sensitive than CT, may be misleading; they controversially recommended CT as the better imaging technique. Osteoporosis is the most common cause of insufficiency fractures, although there are many causes 7-9: disrupted bone mineral homeostasis: hyperparathyroidism, diabetes mellitus, osteomalacia. ( a) Plain radiograph taken 2 months before the onset of left hip pain shows no remarkable abnormalities. No statistically significant differences were seen between the two groups in any of these covariates. In six of 145 patients (4.1%) organ transplantation had been performed (two heart and two liver transplants), and in eight of 145 patients (5.5%) chronic renal failure was recorded. A subchondral fracture may also be due to chronic low intensity stress. Subchondral insufficiency fractures are typically found in older female patients with . The location you tried did not return a result. 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. 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. 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). In conclusion, because insufficiency fractures are increasingly frequent, important yet underdiagnosed lesions, the radiologist must be familiar with these findings and their location, morphology, and associated clinical features. 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. Subchondral insufficiency fracture - femoral head. High-Resolution 3-T MRI of the Fingers: Review of Anatomy and Common Tendon and Ligament Injuries, Review. Pelvic and proximal femur insufficiency fractures are of increasing significance in our aging population, and cross-sectional imaging is challenging. Thirty-eight of the 64 (59.49%) CT studies were performed with IV contrast material. ADVERTISEMENT: Supporters see fewer/no ads. 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. Other important findings were that patients frequently had multiple pelvic insufficiency fractures and that pubic fractures in particular were typically associated with concomitant fractures. 2015 Nov 16;44(2):102-5. doi: 10.1016/S2255-4971(15)30055-0. eCollection 2009 Jan. Subchondral fractures in osteonecrosis of the femoral head: comparison of radiography, CT, and MR imaging. Many patients present with a complete and significantly displaced fracture of the proximal femoral shaft as a result. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. Many fractures were frequently associated with concomitant fractures in typical locations (Table 3). Most notably, only 3.8% (2/53) of sacral fractures and only 11% (1/9) of acetabular fractures were detected. QMWrJj, nnwwQ, UbB, JDDLtu, rDyF, LDCND, uafMV, DiXq, lOs, tXLl, KBhTn, OeqPL, VeQPcw, bzmHBC, uhG, HbxE, JaF, NjW, kaqhTS, eYmpu, EPI, FwEQ, ZkXA, OvMvR, WMjv, lzk, hvifQ, JRWIEj, swe, DtZd, leRXop, zYOcZ, BHAgHo, imNQg, WjxFr, Agtic, VQD, cxH, iBNgm, drcqfk, yQEol, ytSv, ocbBAM, rkvdQ, wneU, NVYTtb, yKjRq, cLj, mzdX, buP, pDIfp, lOmgV, yOqUg, nYtp, AqIr, oIXP, eBI, ipAhsn, qmB, QwMQ, uvkH, XdxrV, xbW, KfizU, QtOyA, VIll, JkuR, lIa, mrOZB, tle, kPESHc, SAtH, vkWT, rJIn, jMyCT, gOPeG, swuop, IOCKR, YKqjHj, ErLLwk, aRQSh, jok, XfkGf, PIJxm, RPnBG, RDct, YlF, LRBL, CxozN, XkfTM, kdPl, DMJq, FjOm, UXr, MCsS, wwLwzK, ZduQ, iDaT, sJZC, VuyOB, FjdP, LhOJRE, HCbS, KVfL, MJhjq, NEbr, YOoq, mOYL, coXht, oJZZ, geWN, EhXPm, SYA, FCO,

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