Subchondral insufficiency fracture
Last revised by Joshua Yap on 22 Feb 2023
Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Yap J, Deng F, et al. Subchondral insufficiency fracture. Reference article, Radiopaedia.org (Accessed on 20 Apr 2024) https://doi.org/10.53347/rID-65145
rID:
65145
Article created:
26 Dec 2018,
Yuranga Weerakkody ◉
Disclosures:
At the time the article was created Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosures
Last revised:
Disclosures:
At the time the article was last revised Joshua Yap had no financial relationships to ineligible companies to disclose.
View Joshua Yap's current disclosures
Revisions:
13 times, by
9 contributors -
see full revision history and disclosures
Systems:
Synonyms:
- Subchondral insufficiency fractures
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.
On this page:
Epidemiology
Risk factors
obesity
abnormal loading through the joint
overuse
Pathology
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.
Location
Typical sites include:
femoral head
femoral condyles
tibial plateau
metatarsal head
Radiographic features
Plain radiograph / CT
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.
MRI
-
T1: there may be a characteristically low signal intensity band through the affected region
parallels the subchondral bone plate (whereas osteonecrosis is curvilinear)
preservation of the articular cartilage (unlike an osteochondral defect)
T2: florid marrow edema
Treatment and prognosis
Complications
secondary osteonecrosis
osteonecrosis with cavitation (crescent sign)
articular collapse
History and etymology
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.
Differential diagnosis
The differential diagnosis of subchondral marrow edema includes:
See also
References
- 1. Yamamoto T. Subchondral insufficiency fractures of the femoral head. (2012) Clinics in orthopedic surgery. 4 (3): 173-80. doi:10.4055/cios.2012.4.3.173 - Pubmed
- 2. Yamamoto T, Takabatake K, Iwamoto Y. Subchondral insufficiency fracture of the femoral head resulting in rapid destruction of the hip joint: a sequential radiographic study. (2002) AJR. American journal of roentgenology. 178 (2): 435-7. doi:10.2214/ajr.178.2.1780435 - Pubmed
- 3. An VV, Broek MVD, Oussedik S. Subchondral Insufficiency Fracture in the Lateral Compartment of the Knee in a 64-Year-Old Marathon Runner. (2017) Knee surgery & related research. 29 (4): 325-328. doi:10.5792/ksrr.17.049 - Pubmed
- 4. Jose J, Pasquotti G, Smith MK, Gupta A, Lesniak BP, Kaplan LD. Subchondral insufficiency fractures of the knee: review of imaging findings. (2015) Acta radiologica (Stockholm, Sweden : 1987). 56 (6): 714-9. doi:10.1177/0284185114535132 - Pubmed
- 5. Vincent VG An, Mathias van den Broek, and Sam Oussedik. Subchondral Insufficiency Fracture in the Lateral Compartment of the Knee in a 64-Year-Old Marathon Runner. (2017) Knee Surgery and Related Research. 29 (4): 325. doi:10.5792/ksrr.17.049 - Pubmed
- 6. William Palmer, Laura Bancroft, Fiona Bonar, Jung-Ah Choi, Anne Cotten, James F. Griffith, Philip Robinson, Christian W.A. Pfirrmann. Glossary of terms for musculoskeletal radiology. (2020) Skeletal Radiology. doi:10.1007/s00256-020-03465-1 - Pubmed
- 7. Ghate SD, Samant A. Subchondral Insufficiency Fracture of Femoral head: Uncommon cause of Hip pain in Elderly. (2012) Journal of orthopaedic case reports. 2 (2): 7-9. Pubmed
Incoming Links
Articles:
- Subchondral insufficiency fracture of the knee
- Foot radiograph (checklist)
- Osteonecrosis of the femoral head
- Femoroacetabular impingement syndrome
- Osteoarthritis of the hip
- Subchondral fracture
- Osteochondral defect
- Acetabular dysplasia
- Osteomeniscal impact oedema
- Differential diagnosis for metatarsal region pain
- Freiberg disease
Cases:
- Subchondral insufficiency fracture of the knee
- Subchondral insufficiency fracture - 2nd metatarsal head
- Subchondral insufficiency fracture of the knee
- Subchondral insufficiency fracture - left femoral head
- Subchondral insufficiency fracture - femoral head
- Subchondral insufficiency fracture - femoral head
- Subchondral insufficiency fracture of talus
- Subchondral insufficiency fracture - femoral head
- Tibial plateau insufficiency fracture
- Spontaneous osteonecrosis of the knee
- Metatarsal fatigue and insufficiency (stress) fractures
- Subchondral insufficiency fracture post lateral meniscectomy
- Subchondral insufficiency fracture - knee
- Subchondral insufficiency fracture - metatarsal head
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scapular fracture
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carpal bones
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- tibia/fibula
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- ankle
- foot
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- pelvis and lower limb fractures by region
- pelvic fracture
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hip
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femoral neck fracture
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trochanteric fracture
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- biceps femoris avulsion fracture
- iliotibial band avulsion fracture
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- patellar fracture
- tibial plateau fracture
- avulsion fractures
- leg
- tibial tuberosity avulsion fracture
- tibial shaft fracture
- fibular shaft fracture
- Maisonneuve fracture
- ankle
- foot
- tarsal bones
- metatarsal bones
- phalanges
- classification by region
- terminology