From the Guidelines
Femoral subchondral impaction fracture is a serious condition that can lead to significant morbidity if left untreated or misdiagnosed. The implications of this condition include progression to osteonecrosis, especially in the case of femoral subchondral or neck stress fractures, for which MRI should be considered as the next line of imaging 1.
Key Considerations
- Patients with osteoporosis or those on bisphosphonate therapy are especially prone to progression of incomplete stress fractures to completion 1.
- Initial management typically involves pain control with medications such as acetaminophen or ibuprofen, as well as immobilization and non-weight-bearing status to prevent further injury.
- Surgical intervention may be necessary to stabilize the fracture and prevent further complications.
- A thorough diagnostic workup, including imaging studies such as X-rays, CT scans, or MRI, is essential to determine the extent of the fracture and guide treatment 1.
- Close monitoring and follow-up with an orthopedic specialist are crucial to ensure proper healing and prevent long-term damage.
Imaging Studies
- MRI without IV contrast should be considered as the next imaging study after initial negative radiographs to prevent delay in diagnosis and preventative treatment 1.
- Follow-up radiographic examination has increased sensitivity compared to initial radiographs, but subchondral insufficiency fractures are typically radiographically occult until collapse or flattening of the articular surface occurs 1.
From the Research
Implications of a Femoral Subchondral Impaction Fracture
The implications of a femoral subchondral impaction fracture can be significant, with potential consequences including:
- Degenerative hip or knee disease, as noted in studies 2, 3, 4
- Collapse of the articular surface, leading to osteoarthritis, as mentioned in 5, 4
- Spontaneous healing or progression to collapse, as reported in 4
- Need for non-operative or operative management, including total hip arthroplasty (THA), as discussed in 5
Risk Factors and Patient Characteristics
Patients with femoral subchondral impaction fractures may have certain risk factors, including:
- Bone insufficiency, as noted in 6
- Osteoporosis, as reported in 5, 6
- History of repetitive physiological stress or microtraumas, as mentioned in 3
- Participation in athletic activities or weightlifting, as discussed in 2, 3
Diagnostic Challenges
Diagnosing femoral subchondral impaction fractures can be challenging, with: