Abstract
Introduction
Subchondral insufficiency fractures of the femoral head (SIFFH) occur with normal or physiological stress in patients with poor bone quality. We evaluated the clinical characteristics of SIFFH.
Methods
Nine cases of SIFFH were treated and followed up for an average of 9 months. Femoral head collapse (FHC) on radiographs was classified as minimal (< 2 mm), moderate (2-4 mm), and severe (> 4 mm). The severity of osteopenia was scored by Singh index (SI). Other characteristics of SIFFH were ascertained by assessing the clinical course as well as Body Mass Index (BMI) and magnetic resonance imaging (MRI).
Results
There were 8 women and 1 man who had a mean age of 67 years. FHC was identified in 6 cases (1 minimal, 3 moderate, and 2 severe). SI scores ranged from 1 to 4. Mean BMI was 22.4 Kg/m2. In all affected hips, MRI demonstrated a subchondral fracture line with localized or diffuse bone-marrow-edema pattern in the femoral head. Initially, all cases were treated with conservative nonweight bearing therapy. In 7 of 9 cases, the pain decreased gradually and disappeared almost completely within 5 months regardless of the extent of FHC, SI score, and BMI. The remaining 2 cases (1 moderate and 1 severe FHC) were treated with total hip arthroplasty due to intractable pain.
Conclusion
This study showed that conservative treatment could be considered as the first treatment choice for SIFFH independent of predisposing factors.
