Subchondral insufficiency fracture
Citation, DOI & article data
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.
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.
- abnormal loading through the joint
Typical sites include:
- knee: can progress to spontaneous osteonecrosis of the knee 5
- femoral head
- femoral condyles
- tibial plateau
- metatarsal head
- secondary osteonecrosis
- osteonecrosis with cavitation (crescent sign)
- articular collapse
- destructive arthropathy
Plain radiography and 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.
T1: may be characteristically low signal intensity band through the affected region
- parallels the subchondral bone plate whereas osteonecrosis is curvilinear
- preservation of the articular cartilage whereas an osteochondral defect is involved
- T2: florid marrow edema
History and etymology
It is described in many regions but the term subchondral insufficiency fracture of "femoral head" was coined by Bangil et al in 1996 7.
The differential diagnosis of subchondral marrow edema includes:
- 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