What is a subchondral fracture of the femoral head?

Abstract. Subchondral insufficiency fracture of the femoral head (SIFFH) is characterized by acute onset hip pain without overt trauma. It appears as a low intensity band with bone marrow edema on T1-weighted MRI. The most common course of treatment is protected weight bearing for a period of several weeks.

What fracture causes avascular necrosis of femoral head?

Avascular necrosis of the femoral head after femoral neck fracture.

What is a subchondral hip fracture?

Subchondral insufficiency fracture (SIF) is the fracture occurring in femoral head without any trauma and usually presents with hip pain [1,2]. The two categories of patients commonly affected are young military recruits and old patients with poor bone stock.

What type of hip fracture is at risk for avascular necrosis?

Avascular necrosis (AVN) of the femoral head is a relatively uncommon complication following an extracapsular hip fracture. Although it can occur following fixation of unstable 3-part or 4-part intertrochanteric fractures with significant posteromedial and posterolateral comminution, it remains a rare complication.

How serious is a subchondral fracture?

Subchondral insufficiency fractures are slowly healing fractures of the bone situated immediately below the cartilage of a joint. The prognosis may range from full recovery to rapidly escalating joint destruction.

How is a subchondral fracture treated?

Subchondroplasty is a technique indicated for treatment of early subchondral fractures or stress related marrow edema associated with osteoarthritis and involves the injection of synthetic calcium phosphate into the trabecular space, providing mechanical support.

What is femoral head AVN?

Avascular necrosis (AVN) of the femoral head is a pathologic process that results from interruption of blood supply to the bone. AVN of the hip is poorly understood, but this process is the final common pathway of traumatic or nontraumatic factors that compromise the already precarious circulation of the femoral head.

How is AVN diagnosed?

MRI and CT scan. These tests produce detailed images that can show early changes in bone that might indicate avascular necrosis.

How is AVN of the hip diagnosed?

An MRI is considered the gold standard for diagnosing AVN of the hip because it can detect the disease more quickly than radiography. It has a sensitivity of more than 99%, can detect crescent signs earlier, and is capable of detecting bone marrow changes including edema and sclerosis sooner than plain radiographs.

How do you fix a subchondral fracture?

Prompt diagnosis and conservative management (immediate non-weight bearing followed by partial weight bearing as tolerated) are keys to successful treatment. Teriparatide has been proposed as treatment for subchondral insufficiency fractures based on animal studies, but it remains an experimental treatment in humans.