Subchondral insufficiency fracture

Last revised by Joshua Yap on 22 Feb 2023

Subchondral insufficiency fracture refers to a type of stress fracture that occurs below the chondral surface on a weight-bearing surface of a bone due to mechanic failure of subchondral cancellous bone.

  • osteoporosis

  • obesity

  • abnormal loading through the joint

  • overuse

They tend to occur when normal physiological forces are repeatedly applied to an area of bone. Callus formation occurs along with non-mineralized osteoid and the absence of bone infarction.

Typical sites include:

Radiographs are normal preceding the development of callus formation or collapse of the articular surface. Linear or patchy subchondral sclerosis may be present representing cancellous fracture.

  • T1: there may be a characteristically low signal intensity band through the affected region

  • T2: florid marrow edema

It has been described in many regions but the term "subchondral insufficiency fracture of the femoral head" was coined by Bangil et al. in 1996 7.

The differential diagnosis of subchondral marrow edema includes:

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Cases and figures

  • Case 1: metatarsal head
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  • Case 2: knee
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  • Case 3: knee
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  • Case 4: metatarsal head
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  • Case 5
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  • Case 6
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  • Case 7
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