Presentation
Pain on walking, bilateral limp and painful hip, left more than right.
Patient Data
Bilateral aspherical femoral heads with femoro-acetabular uncovering and broad necks. The neck of left femur demonstrates interrupted trabecular pattern with a doubtful cortical overriding at medial margin suggesting a fracture.
Coronal and axial oblique images exhibit typical piston-grip deformity of bilateral proximal femora, lack of femoral neck concavity, diminished femoral head-neck offset, aspherical femoral heads, acetabulo-femoral uncovering and bony bump with subchondral edema at anterosuperior neck. The lateral femoral tubercles are also prominent. These features are compatible with bilateral CAM type of femoroacetabular impingement (FAI type 1).
The right hip reveals linear knife like hyper intensity at anterior labrum along the articular surface reaching midsubstance of labrum, suggesting partial anterior labral tear.
The left hip reveals a large anterosuperior complete labral tear with intervening fluid cleft ( 10 - 2 o'clock position). A chronic femoral neck fracture is seen with marrow edema and cortical overriding with minimal edema at iliopsoas muscle and small volume joint effusion.
Case Discussion
MRI pelvis reveals left femoral neck fracture with bilateral femoroacetabular impingement FAI type 1 (or CAM type of FAI) with anterosuperior labral tears (partial tear at right hip and complete tear at left).
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