HHS Vulnerability Disclosure, Help Insufficiency fractures are a type of stress fracture, which are the result of normal stresses on abnormal bone. Although skeletal complications are infrequent, radiation-associated bone fractures are still serious complications in 220% of patients treated with limb-sparing surgery and RT [7]. (2005) ISBN:1588904458. - 22 , : . Cruess RL. Pathologic fractures after surgery and radiation for soft tissue tumors. A healthy 52-year-old Japanese woman presented with a slowly growing, painful soft tissue mass over her proximal calf. Histopathologic findings of spontaneous osteonecrosis of the knee at an early stage: a case report. buzzword, , . While MRI is the most sensitive technique in the visualization of insufficiency fractures, CT sometimes tends to depict the extent and stability of these fractures better. Osteonecrosis of the knee: a review of three disorders. Burgener FA, Kormano M, Pudas T. Bone and Joint Disorders. 61-year-old female patient with a history of bronchial carcinoma, FDG-PET-CT showing only moderate metabolic activity in the thoracic spine with several compression fractures. The characteristic findings of SIFK include a hypointense line in the subarticular bone marrow representing a subchondral fracture and focal depression of the subchondral bone plate. SIFK is a type of stress fracture that occurs when repetitive and excessive stress is applied to the subchondral bone. The synovium folds over the Anteroposterior radiograph of the pelvis demonstrates areas of sclerosis in both sacral ala (, Axial MRI (STIR-sequence) of the pelvis demonstrating bone marrow edema pattern in bilateral sacrum compatible with bilateral insufficiency fractures, Axial MRI (T1-w-sequence) demonstrating signal loss in both sacral ala compatible with bilateral insufficiency fractures in a 55-year-old woman after radiotherapy of the pelvis for cervical carcinoma, AP radiograph of both hip joints shows insufficiency fractures (, Coronal CT-reformation of the sacrum demonstrates sacral insufficiency fractures at S1 with fracture lines and sclerosis. The purpose of this paper is to review the clinical presentation, pathophysiology, image findings, complications and outcome of SIFK. Lateral radiograph of the distal femur and knee shows severe osteopenia but no fracture. Epub 2018 Jan 7. There was a 1.5 5-cm subchondral defect at the weight-bearing surface of the lateral femoral condyle. However, we were concerned about postoperative complications such as deep infection because the surrounding soft tissue would be also compromised from RT. about navigating our updated article layout. Y.H.B.T. Obvious callus formation around the fracture site was observed at 3 and 6 months after treatment (arrows). On bone scan, there is increased activity at the site of the fracture. Her physical examination revealed a hard, tender, palpable 65 cm mass with moderate mobility under the right proximal calf without restriction of right knee range of motion. It is not clear whether LIPUS did decrease fracture healing time. The potential benefits include preservation of the native joint kinematics and proprioception, lower risk of deep vein thrombosis, and less total blood loss [. In this case report, a middle-aged lady with SIFK of the lateral femoral condyle was successfully treated with UKA with satisfactory improvement in symptom and functional performance. ? Zhang R, Wang Z, Zhu G, et al. Knee Surgery, Sports Traumatology, Arthroscopy. This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (, Fractures, Bone; Radiotherapy; Sarcoma; Ultrasonic Waves. There is a potential limitation in this study. Patients with subchondral insufficiency fracture characteristically have Dose distribution of the radiation therapy was shown. Further progression of osteonecrosis at the lateral femoral condyle with a displaced curvilinear bony lesion was noted (, At 2weeks after the hospital admission, a left UKA for the lateral compartment was performed. Findings include sclerosis, lytic fracture line, bone expansion, exuberant callus, and osteolysis. Dangoor A, Seddon B, Gerrand C, et al. Three of the five had subchondral changes of either insufficiency fractures or true fractures, while one patient had equivocal findings. Significance of dose in postoperative radiotherapy for soft tissue sarcoma. MRI features of a malignant fracture are diffusely or focally abnormal bone marrow signal which may be either well-defined or ill-defined and does not follow fracture lines. Bethesda, MD 20894, Web Policies collected clinical data and prepared the manuscript. Prediction of pathologic fracture risk of the femur after combined modality treatment of soft tissue sarcoma of the thigh. 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. Preoperative radiograph. PMC legacy view We appreciate the help of Drs. (b) A 1.5 5-cm intra-articular dislodged cartilage fragment was retrieved. official website and that any information you provide is encrypted To the best of our knowledge, this is the first case report describing LIPUS being used to treat a radiation-associated insufficiency fracture. In these subjects pharmacotherapy for osteoporosis is warranted (Mallmin and Ljunghall. Outcome of SIFK depends on several factors, including the initial subchondral fracture size, patient BMI, degree of osteopenia, as well as early diagnosis and initial treatment. Bookshelf (a) Coronal proton-density-weighted fat-suppressed and (b) T1-weighted MRI images of left knee demonstrated subchondral insufficiency fracture at the lateral femoral condyle with a curvilinear hypodensity parallel to the femoral condyle subchondral bone plate. Careers. 2022 May; 40 (5):443-457. Although we assumed that a negative-margin R0 resection was achieved, the lesion was in close proximity to the tibial artery and nerve. 1 The prognosis may range from full recovery to rapidly escalating joint destruction. Total and unicondylar knee arthroplasty are equivalent treatment options in end-stage spontaneous osteonecrosis of the knee, and the size of the lesion has no influence on the results. After 3 courses of neoadjuvant chemotherapy with ifosfamide and doxorubicin hydrochloride, we performed surgery. After 2 courses of adjuvant chemotherapy with ifosfamide and doxorubicin hydrochloride, adjuvant RT was administered, with a total of 60 Gy in 30 fractions (Figure 4). April 3, SIFK is a type of stress fracture that occurs when repetitive and excessive stress SIT, "-" , . Accuracy for differentiating malignant fractures from stress fractures was reported to be highest with MRI (9398%) followed by CT (8288%) and radiographs (8894%) (Fayad et al. LIPUS could be a safe and effective treatment option in the management of radiation-associated pathological fractures. She was allowed to gradually increase partial weight-bearing as long as she remained pain-free for next 7 months. Atypical uptake patterns may be difficult to interpret and abnormal uptake may persist for several months. Subchondral insufficiency fracture of the knee (SIFK) is a potentially devastating disorder that may progress rapidly to osteoarthritis with articular surface collapse. The Koshino classification was first described in 1979, where small radiolucent lesions measuring <3.5 cm, The options of nonoperative treatment for early-stage SIFK include physiotherapy, analgesics, nonsteroidal anti-inflammatory drugs, and bisphosphonates [. They are most often seen in the setting of osteoporosis, although any process which weakens bone is a risk factor. The addition of (neo)adjuvant radiation therapy (RT) improves local control after surgical resection [2]. In terms of safety, Busse et al reported no adverse events associated with LIPUS treatment in a randomized clinical trial (Re-evaluation of low-intensity pulsed ultrasound in treatment of tibial fractures (TRUST)) [14]. Authors' contribution: C.H.L. In a review by Sibilska etal., the prevalence of SIFK is reported at 3.4% in elderly patients [. J Bone Joint Surg Am. Hatanaka H, Yamamoto T, Motomura G, Sonoda K, Iwamoto Y. Skeletal Radiol. The Journal of bone and joint surgery. This is the first case report to describe the multiple occurrence of collapsed subchondral insufficiency fracture both in the femoral head and medial femoral condyle in a 69-year-old obese man. LIPUS could be a safe and effective treatment option for the management of radiation-associated pathological fractures. Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Check for errors and try again. Thieme Medical Pub. There was extrusion of the lateral meniscus. (2011). Most cases involve the medial femoral condyle, and the lateral femoral condyle is rarely affected. Re-evaluation of low intensity pulsed ultrasound in treatment of tibial fractures (TRUST): Randomized clinical trial. Image, Download Hi-res MRI is used to confirm the presence of and evaluate subchondral signal ( Fig 1 ). Marshall RA, Mandell JC, Weaver MJ, Ferrone M, Sodickson A, Khurana B. DOI: https://doi.org/10.1016/j.artd.2022.04.002. The lesion had low and high signal intensity on T1- and T2-weighted images, respectively (Figure 2). AJR Am J Roentgenol. While prophylactic intramedullary nailing is a common approach for preventing radiation-associated fractures, especially in the diaphysis of long bones [4], it has been suggested that prophylactic nailing should not be routinely performed because the risk of fracture is low. Low intensity pulsed ultrasound enhances fracture healing in both ovariectomy-induced osteoporotic and age-matched normal bones. Abstract Objective: To propose an magnetic resonance imaging (MRI) grading system for subchondral insufficiency fracture of the knee (SIFK) to predict outcome and assess risk factors. . Bone scintigraphy is highly sensitive, but not specific. Therefore, the entire popliteus muscle and the adjacent tibial periosteum were resected. It should be The Journal of the American Academy of Orthopaedic Surgeons. We appreciate the help of Dr. Sanshiro Inoue in the discussion section. LIPUS accelerated the repair of fractures during various steps of the fracture repair process in an animal model [11]. W B Saunders Co. (2001) ISBN:0721690270. Treatment depends on the location and whether the fracture is complete or incomplete. The .gov means its official. Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound. (A) Microscopic image of the biopsy specimen (hematoxylin-eosin; HE) showed a densely cellular monomorphic population of spindle cells with focally whorled areas. Subchondral insufficiency fracture of the knee (SIFK) is a potentially devastating disorder that may progress rapidly to osteoarthritis with articular surface collapse. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Protection and Quality Assurance in Bone Densitometry, Osteoporosis and Bone Densitometry Measurements. MB), Redistribute or republish the final article, Translate the article (private use only, not for distribution), Reuse portions or extracts from the article in other works, Distribute translations or adaptations of the article. Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong. Management of radiation-associated fractures. Recently, low-intensity pulsed ultrasound (LIPUS) has been widely used to treat fresh and nonunion fractures [6]. 2. Before buzzword, , . Ochi J, Nozaki T, Nimura A, Yamaguchi T, Kitamura N. Jpn J Radiol. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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 Third, is there any method of halting the progression of early subchondral changes before they progress into collapse, flattening, and loose-body formation? Jpn J Radiol. The treatment of SIFK can be nonoperative or operative depending on the size and radiological staging of the lesion. In total, she was able to walk without crutches at 8 months after initiation of LIPUS therapy. Pathology They tend to occur when normal physiological forces are repeatedly applied to an area of bone. MRI showed that the low-intensity area on T1-weighted images (Figure 6A, 6E, arrows) and the high-intensity area on short TI inversion recovery (STIR) images (Figure 6I, arrowhead) both decreased in size over time. Though MRI is very sensitive for detection of fractures, bone marrow changes, and related soft-tissue edema, it should be considered that in the absence of fractures lines or a typical history MRI may also be misleading and suggest other bone marrow pathology such as malignant infiltration. Her height and weight were 146.9 cm and 57.2 kg, respectively. Careers. In general, they are seen in the elderly, more frequently in women 2. However, there have been no reports that such methods could prevent the collapse of the articular surface in the case of a radiation-associated fracture. will also be available for a limited time. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2000 Jun;82(6):858-66. doi: 10.2106/00004623-200006000-00013. The timeline of the clinical course is summarized in Figure 7. (E) T2-weighted sagittal image with fat suppression. In addition to LIPUS, she started non-weight-bearing walking for the first 3 weeks. Two cases of subchondral insufficiency fractures of the femoral head are reported, and magnetic resonance imaging establishes the diagnosis and rules out other conditions. The https:// ensures that you are connecting to the We adopted the spacer block technique and resected the tibia first. . Bonewald LF, Dallas SL. PET-CT excludes malignant fractures due to underlying disease, A common site of fragility fractures is the distal forearm. Three questions need to be answered. Please enable it to take advantage of the complete set of features! Papanna MC, Tafazal S, Bell MJ, et al. After 1 year, remodeling of the fracture callus was complete. Cheung et al reported that in ovariectomized rats, LIPUS was associated with significantly enhanced callus formation, faster mineralization, and better remodeling in the closed femoral fracture group than in the control group [12]. However, as SIFK is predominantly localized to a single compartment, and in view of the favorable outcome of treating unicompartmental osteoarthritis with UKA, there has been growing interest in treating SIFK with UKA as an alternative to TKA. - . Regarding the effect of radiation on osteogenesis, an in vitro experiment showed that LIPUS restored the viability of suppressed cells and osteogenic differentiation of radiation-damaged rat mandible-derived bone marrow mesenchymal stem cells [13]. and transmitted securely. Treatment depends on the location and whether the fracture is complete or incomplete. We report a case of radiation-associated insufficiency fracture of the tibial plateau after surgery, perioperative chemotherapy, and adjuvant radiation therapy for synovial sarcoma of the proximal calf that was successfully treated with low-intensity pulsed ultrasound (LIPUS). The optimal treatment for spontaneous insufficiency fracture of the lateral femoral condyle remains undetermined, and there are no previous dedicated reports on treatment outcome with unicompartmental knee arthroplasty. . By clicking accept or continuing to use the site, you agree to the terms outlined in our. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons. J Bone Joint Surg Am. Multidetector computed tomography (MDCT) is currently standard and allows multiplanar reconstruction, near isotropic 3D reconstructions of anatomical structures, reduction of artefacts as well as thin-section high-resolution imaging which is beneficial to visualizing also subtle fracture lines. this study, subchondral insufficiency fracture has been increasingly studied, including the identification of risk factors and associated lesions (3). A 52-year-old Japanese woman with no significant medical history presented with a slowly growing and painful mass over her proximal calf. MB), Help with (2017) Journal of children's orthopaedics. "-" , , . LIPUS, low-intensity pulsed ultrasound; M, months. Yuna Inaba, Kosuke Makihara, and Masanori Hisaoka, who diagnosed the patient and obtained photographs of resected specimens and histological images. First, does spontaneous osteonecrosis of the knee in fact exist? . . HHS Vulnerability Disclosure, Help Whether new arthroscopic techniques can provide the necessary intervention to halt osteoarthritic sequelae remains unanswered. Corresponding Author: Tomoya Matsunobu, e-mail: Received 2021 Aug 11; Revised 2021 Nov 29; Accepted 2021 Oct 27. We also assumed that this would be a refractory fracture. This is the first report of radiation-associated pathological fracture that was successfully treated with LIPUS. The diagnosis of an insufficiency fracture was supported by CT follow-up studies that showed fracture lines more clearly and areas of increased sclerosis or periosteal bone formation; and by MRI follow-up studies that showed persistent or decreasing areas of bone marrow edema or better visualization of fracture lines. Data Analysis Subchondral insufficiency fracture of the knee typically affects individuals that are 55 or older and presents with sudden non traumatic unilateral knee pain. (a) Anteroposterior and (b) lateral radiographs of left knee taken at 6 months postoperatively, and (c) scanogram of lower limbs taken on postoperative day 5, showing in situ UKA implants. The site is secure. It should be suspected in RT is associated with various complications including skeletal complications, skin disorders, joint stiffness, joint fibrosis, joint contracture, pain, lymphedema, and neuropathy [2]. Spontaneous osteonecrosis of the knee: what do we know so far? There was associated osteoarthritic changes at the lateral compartment of the femorotibial joint, while other compartments remained relatively unaffected. In the case of pubic fractures in 90% concomitant fractures were present. Coronal T1-weighted images (AD), sagittal T1-weighted images (EH), and sagittal T2-weighted images with fat suppression of the right knee taken immediately after the onset of the knee pain, and 4 months, 10 months, and 16 months after initiation of LIPUS therapy. Knee pain had completely disappeared 1 year after initiation of LIPUS therapy. The degree of confidence is low in sacral fractures because of osteoporosis, overlying bowel gas, and calcified vessels and is better at peripheral sites like in long bones and the metatarsal bones. At 5 months after surgery and 2 months after the completion of radiation therapy, she developed an insufficiency pathological fracture of the proximal tibia without any apparent trauma. 8600 Rockville Pike The In view of the isolated compartment involvement, unicompartmental knee arthroplasty was performed with satisfactory outcome. Background. The lesion, measuring 722217 mm on magnetic resonance imaging (MRI), appeared as a tumor with clear margins in the popliteus muscle. Heckman JD, Ryaby JP, McCabe J, et al. Depending on the tumor location, concomitant surgical resection of the periosteum might be required; periosteum stripping and RT reportedly increase the risk of the pathological fracture [4]. Kabra U, Subchondral insufficiency fracture of the knee. . The typical findings of subchondral insufficiency fracture of the knee on magnetic resonance imaging (MRI) include cortical thickening associated with high-intensity MRI scans and the identification of risk factors and associated lesions. Histopathology findings were consistent with synovial sarcoma, monophasic type (Figure 3). After perioperative ifosfamide and doxorubicin chemotherapy and surgical resection, adjuvant radiation therapy was administered, with a total of 60 Gy in 30 fractions. The answer is "probably," but much more rarely than initially believed. Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses. Burnet S, Mahadevan G, Lee A et-al. Unicompartmental knee arthroplasty for spontaneous osteonecrosis of the knee: a meta-analysis. Gortzak Y, Lockwood GA, Mahendra A, et al. 4. Sacral, iliac, and supra-acetabular fractures often are difficult to detect. First described in 1968, spontaneous osteonecrosis of the knee (SONK) is a distinct clinical entity that is a common cause of acute, unilateral knee pain and swelling. The patients pain was exacerbated with knee extension. MeSH Subchondral insufficiency fracture of the knee | Radiology Reference Article | Radiopaedia.org. Radiology Review Manual. Low signal intensity (A and E, arrows) on T1-weighted images and high signal intensity (I, arrowhead) on short TI inversion recovery (STIR) images in the proximal medial tibia disappeared over time. Current concepts as to etiology and pathogenesis. Epub 2021 Nov 29. The answer appears to be "no" because early subchondral fractures and early spontaneous osteonecrosis of the knee are treated conservatively and only the later changes of subchondral surface collapse are treated more aggressively with joint replacement. Radiographic findings depend on the site of the fracture. , , , , , , . sharing sensitive information, make sure youre on a federal Many lines of evidence suggest that adjuvant RT reduces local recurrence rate in the setting of limb-sparing surgery. Thrombophilia-Associated Factors in Patients with Spontaneous Osteonecrosis of the Knee. AJR Am J Roentgenol. Subchondral insufficiency fracture of the knee (SIFK) is a potentially devastating disorder that may progress rapidly to osteoarthritis with articular surface collapse. FOIA Low-intensity pulsed ultrasound modulates RhoA/ROCK signaling of rat mandibular bone marrow mesenchymal stem cells to rescue their damaged cytoskeletal organization and cell biological function induced by radiation. A middle-aged lady presented with subacute left knee pain and a locked knee. This article presents a 51-year-old postmenopausal woman, a physician, who had subchondral insufficiency fractures of the knee associated with prolonged standing during clinical work and was treated with partial weight bearing on crutches and viscosupplementation to improve bone healing. Polymerase chain reaction showed SS18-SSX1 gene rearrangement (data not shown). Spontaneous Osteonecrosis/Subchondral Insufficiency Fractures of the Knee: High Rates of Conversion to Surgical Treatment and Arthroplasty. 28 (6): 413-20. Accessibility It is an intra-articular structure, but it is extra-synovial. Helmstedter CS, Goebel M, Zlotecki R, Scarborough MT. LIPUS is a clinically established treatment used to accelerate long bone fracture healing. Subchondral insufficiency fractures are slowly healing fractures of the bone situated immediately below the cartilage of a joint. Disclaimer, National Library of Medicine There was surrounding bone marrow edema-like signals at the lateral femoral condyle. Patients with subchondral insufficiency fracture characteristically have unremarkable plain radiographs, while MRI examination may reveal extensive bone marrow edema and subchondral bone collapse. Subchondral insufficiency fractures of the knee is also known as spontaneous osteonecrosis of the knee (SONK). 1 article features images from this case Subchondral insufficiency fracture of the knee (SIFK) is a common cause of knee joint pain in older adults. Plain radiographs of the right knee showed no abnormalities caused by the soft tissue tumor or osteoarthritis (Figure 1). By definition,secondary osteonecrosis of the knee occurs secondary to an insult. Subchondral insufficiency fracture of the knee (SIFK) is a potentially devastating disorder that may progress rapidly to osteoarthritis with articular surface collapse. Looser zones are also a type of insufficiency fracture. ! It should also be noted that multiple pelvic insufficiency fractures are frequently found, particularly in the presence of pubic or acetabular fractures, and careful search for concomitant fractures is warranted. Typical MRI findings in insufficiency fractures include a pattern of bone marrow edema with a low-signal-intensity line (resp. Note the dose of 59 Gy was delivered to the posterior segment of the tibia (red line). We report a case of radiation-associated insufficiency fracture of the tibial plateau after surgery and RT for synovial sarcoma of the calf that was successfully treated with LIPUS. It is well-known that patients with distal radius fracture who are otherwise healthy have a preferential bone loss at the distal forearm. 2001;40 (9): 1065-6. Local tenderness resolved within 6 months. Steps required to perform operative fixation of an insufficiency fracture within the knee using calcium phosphate bone substitute. The patient is a 75-year-old male, recreational golfer found to have an area of bone marrow edema corresponding to a recent injury. (A) Axial view, (B) sagittal view, and (C) coronal view. Mears SC, McCarthy EF, Jones LC, Hungerford DS, Mont MA. Treatment of spontaneous osteonecrosis of the knee (SPONK) by a bisphosphonate. The most common finding is a sclerotic band or line. Radiographics : a review publication of the Radiological Society of North America, Inc. MRI features that aid in diagnosis of acute traumatic injuries, subchondral insufficiency fracture, and its potentially irreversible form, spontaneous osteonecrosis of the knee include the location and extent of bone marrow edema, the presence of a fracture line, a hypointense area immediately subjacent to the sub chondral bone plate, and deformity of the subChondralBone plate. The https:// ensures that you are connecting to the At 1month after the initial emergency department presentation, the patient returned to the hospital again and was admitted to the orthopaedics and traumatology unit. On laboratory testing, serum calcium and phosphorus and renal and liver function were within normal limits. Early diagnosis is best made with a bone scan or MRI, as plain films may initially appear normal. Funding: This study did not receive any funding. Intraoperative photos. An official website of the United States government. Ethics approval was obtained from the New Territories West Cluster Research Ethics Committee of Hospital Authority, Hong Kong. , () (CRM), . You will then receive an email that contains a secure link for resetting your password, If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password. fracture) on the T1-weighted images parallel to the subchondral bone. (a) A 1.5 5-cm subchondral defect was found at the weight-bearing surface of the lateral femoral condyle. Chen C, Chandnani V, Kang HS et-al. government site. Federal government websites often end in .gov or .mil. (d) Lateral UKA was performed. 2022, Received in revised form: Standard weight-bearing anteroposterior (AP) radiographs at 0 and 30 of flexion, sunrise radiographs, and lateral radiographs of the knee should be ordered to evaluate the level of osteoarthritis or presence of osteochondritis dissecans lesions. PMC , , In general, the circumscribed lesions on MRI, which are commonly observed in osteonecrosis, are not found (Yamamoto et al. , . Distinct radiolucent areas at the lateral femoral condyle may be observed in advanced cases with subchondral collapse. In particular, initially she only performed partial weight bearing starting at 30% of her body weight for 3 months, and steadily built up to full weight bearing as tolerated for the next 4 months. In five of the authors' most recent MRIs in patients For conventional tibial plateau fractures, internal fixation with locking plates using the minimally invasive percutaneous osteosynthesis technique could be an option. Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. They should not be confused with fatigue fractures which are due to abnormal stresses on normal bone, or with pathological fractures, the result of diseased, weakened bone due to focal pathology such as tumours (both malignant and benign). appears to represent a subchondral insufficiency fracture another hypothesis is an association with a meniscal root tear Physical Exam Symptoms pain with weightbearing, especially sitting to standing Imaging Radiographs first line imaging studies AP knee lateral knee merchant view knee findings wedge-shaped lesion on imaging MRI most useful study Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. 8600 Rockville Pike The patient was treated with LIPUS for 1 year. Histological examination of core needle biopsy specimens led to a pathological diagnosis of synovial sarcoma. Outcome of SIFK depends on several factors, including the initial subchondral fracture size, patient BMI, degree of osteopenia. Insufficiency fracture. Arthroscopic microfracture treatment for osteonecrosis of the knee. The causes of these lesions include contusions from trauma (with or without cruciate ligament injuries), insufficiency fractures, degenerative cartilage lesions, spontaneous Twelve cases are described in which the clinical entity of oste onecrosis of the femoral condyle was diagnosed because the patients had a clinical picture identical to that of osteonecrosis and also had positive bone scans, however, roentgenographic changes supposedly diagnostic of the condition were not seen. A lateral parapatellar approach was used. Subchondral insufficiency fractures of the knee (SIFK) are painful, nontraumatic fractures that occur predominantly in the medial femoral condyle of postmenopausal osteoporotic women in their fifth and sixth decades of life. Mild internal enhancement was observed on gadolinium-enhanced fat-suppressed T1-weighted images (Figure 2). The answer appears to be "maybe" as non-weight-bearing conservative therapy has not consistently prevented progression of the disease. Subchondral insufficiency fracture of the knee is , , . sharing sensitive information, make sure youre on a federal All 10 complications occurred between 2 and 9 months after injection: six (60%) in the hip and four (40%) in the knee. The clinical data used during the current study are available from the corresponding author on reasonable request. We only described 1 case and summarized our experience with therapeutic evaluation of LIPUS for insufficiency radiation-associated fracture of the tibial plateau. Parasymphyseal and pubic ramus fractures may have an aggressive appearance that depends on the stage of fracture maturity. In a previous study in 70.3% of cases with pelvic insufficiency fractures, multiple fracture sites were present. Therefore, LIPUS could be a safe and effective treatment option in the management of radiation-associated fractures. Preoperative CT. (a) Axial and (b) coronal plain CT images of left knee demonstrated flattening of the lateral femoral condyle and a subchondral lesion. (c) From left to right: the resected SIFK lesion during distal femur cut, the dislodged cartilage fragment, and the tibia cut. fracture) on the T1-weighted images parallel to the Conclusion T1WI, T1-weighted images; STIR, short TI inversion recovery; LIPUS, low-intensity pulsed ultrasound; M, months. Accessibility Restoration of the trabecular structure was eventually observed without obvious collapse of the articular surface (Figure 5E, 5F, 5K, 5L). National Library of Medicine Low-intensity pulsed ultrasound accelerates rat femoral fracture healing by acting on the various cellular reactions in the fracture callus. A 1.5 5-cm intra-articular dislodged cartilage fragment was retrieved (, The lateral UKA was performed using the Zimmer Unicompartmental High Flex Knee system (ZUK; Zimmer, Warsaw, IN). Zagars GK, Ballo MT. It should be suspected in the appropriate clinical setting, as in early stages it is usually indistinct on initial plain radiographs and magnetic resonance imaging is required for a definitive diagnosis. (A, B) T1- and T2-weighted axial images, respectively. 2022. All authors read and approved the final manuscript. Findings suggested that SPONK was the result of a subchondral fracture rather than primary osteonecrosis, rather than antecedent bone infarction such as creeping substitution and bone marrow necrosis. Usually a concave or wedge-shaped deformity of the affected vertebra is found and a wide range of the vertebral height ratios and fracture distribution were reported (Kawaguchi et al. Spontaneous osteonecrosis of the lateral femoral condyle of the knee: a report of 11 cases. Post-arthroscopic osteonecrosis of the medial tibial plateau: a case series. Spontaneous insufficiency fracture of the knee is a potentially devastating yet poorly understood disease entity that can lead to secondary osteoarthritis. This site needs JavaScript to work properly. Subsequent imaging studies revealed a spontaneous insufficiency fracture of the lateral femoral condyle. https://radsource.us/subchondral-insufficiency-fracture-of-the-knee Typical MRI findings in insufficiency fractures include a pattern of bone marrow edema with a low-signal-intensity line (resp. and transmitted securely. JJ Abstract Subchondral insufficiency fracture of the knee (SIFK) is a common cause of knee joint pain in older adults. Despite the large central defect at the lateral femoral condyle, we could still identify the correct extension gap with the remaining bone. Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome A SIFK grading system for MRI is introduced. For the patients with advanced disease who failed conservative management, TKA has been the last-resort treatment. Tel. The histologic findings of avascular areas in biopsy specimens appear to be a secondary phenomenon and not the primary cause. Abstract Objective: To assess the relationship between low- and high-grade subchondral insufficiency fracture of the knee (SIFK) and meniscal tear/type/location, severity of meniscal 2022 May;40(5):443-457. doi: 10.1007/s11604-021-01224-3. Spontaneous osteonecrosis of the knee (SONK/Morbus Ahlback) mainly affects the medial condyle of elderly women and the outcome is unpredictable in many cases. An important differential diagnosis of a stress/insufficiency fracture is a fracture due to malignant disease. Effect of ibandronate on spontaneous osteonecrosis of the knee: a randomized, double-blind, placebo-controlled trial. Chemo chemotherapy; LIPUS low-intensity pulsed ultrasound. 2022, Received: Insufficiency fractures at the spine are a leading cause for acute low back pain without an acute traumatic event. Radiographs are the initial imaging test in patients with pain localized to the skeleton. The histopathological findings suggest that the primary event leading to spontaneous osteonecrosis of the knee is a subchondral insufficiency fracture and that the localized osteoarthritic changes seen in association with this disease is the result of a fracture. , . 3. Creative Commons Attribution NonCommercial NoDerivs (CC BY-NC-ND 4.0), Yan Ho Bruce Tang, MBBS(HKU), MRCSEd, FHKCOS, FRCSEd(Orth), FHKAM(Orthopaedic Surgery), https://doi.org/10.1016/j.artd.2022.04.002, A Case of Subchondral Insufficiency Fracture of the Knee at Lateral Femoral Condyle Treated With Unicompartmental Knee Arthroplasty, Spontaneous insufficiency fracture of the knee, View Large It should be considered, however, that MRI is more sensitive and the imaging modality of choice if the patient history suggests malignant disease and metastasis may be responsible for fracture. 5. 1990;154 (5): 1025-7. Rheumatology (Oxford). CT-guided core needle biopsy was performed. Pathophysiology may represent a subchondral insufficiency fracture also believed to be caused by a meniscal root tear Presentation Symptoms sudden onset of severe knee pain effusion limited range of motion secondary to pain tenderness over medial femoral condyle Imaging Radiographs recommended views standing AP and lateral of hip, knee and ankle We assumed that this insufficiency fracture resulted from the stripping of the periosteum from the proximal tibia and adjuvant RT. The patient remained free of symptoms and had no recurrences for 2 years after surgery. Upon admission, the patient was found to have left knee tenderness, predominantly over the lateral joint line. Of the included 1000 patients, 545 (54%) were women, but they had nine of the 10 (90%) complications ( P = .02). , . Distal radius fractures are also associated with generally low bone mass and elevated fracture risk at other skeletal sites. The surrounding bone edema often involving the entire femoral condyle is in contrast to the more localized edema adjacent to cartilage loss observed in cases of osteoarthritis [. Wide local resection is the mainstay of treatment for high-grade soft tissue sarcoma in the extremities [1]. Recent progress in RT has led to better outcomes and fewer adverse events. Theoretically, minimally invasive techniques such as stabilization with locking plate augmentation could be applicable to any type of tibial plateau fracture. First, does spontaneous osteonecrosis of the knee in fact exist? Coronal STIR MR sequence of both lower extremities demonstrating marrow edema and subtle fracture line due to insufficiency fracture at the right fibula, AP radiograph of the left knee demonstrating an old insufficiency fracture of the right fibula with callus formation after total knee replacement, Dorso-plantar radiograph of the right foot demonstrates insufficiency fracture of the second and third with massive callus formation in this 85-year-old female patient, AP radiograph of the right proximal femur with sclerosis and subtle fracture line at the medial aspect of the femur shaft below the lesser trochanter (, Patient with history of tumor endoprosthesis at the proximal femur and insufficiency fracture at the proximal tibia. Thus, it appears most patients with what has been called spontaneous osteonecrosis of the knee actually have subchondral insufficiency fractures. Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Adverse effects of ionizing radiation are histologically consistent with decreased osteocyte counts, suppressed osteoblastic activity, and diminished vascularity [9,10], which lead to impairment of bone regeneration at a fracture site. However, MRI revealed transverse bone marrow edema with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images in the proximal medial tibia, indicating an insufficiency pathological fracture caused by RT (Figure 6). The authors declare that there are no conflicts of interest. . SIFK typically presents with acute knee pain localized to the area of the subchondral fracture [ 1, 2 ]. The imaging modality of choice is MRI with T2-weighted and proton-density-weighted sequences. MRI signals and time course of the resolution for the insufficiency fracture in the proximal medial tibia. At 1 year postoperatively, the patient had complete resolution of knee pain and was able to resume working. - , , ? Intraoperative joint inspection confirmed SIFK of the lateral femoral condyle. Options, therefore, include: Treatment of the underlying cause of bone weakness is also essential. Early MRI diagnosis and non-surgical management of spontaneous osteonecrosis of the knee. 7. 2016 May;45(5):713-6. doi: 10.1007/s00256-016-2328-4. Before 11 (3): 191-194. 2020 May 6;102(9):821-829. doi: 10.2106/JBJS.19.00381. The .gov means its official. Histological evaluation of spontaneous osteonecrosis of the medial femoral condyle and short-term clinical results of osteochondral autografting: a case series. (1999) Seminars in arthritis and rheumatism. Most patients with what has been called spontaneous osteonecrosis of the knee actually have subchondral insufficiency fractures, and the histologic findings of avascular areas in biopsy specimens appear to be a secondary phenomenon and not the primary cause. If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. Options, therefore, include: 1. conservative management 2. plaster cast 3. internal fixation 4. vertebroplasty 5. kyphoplasty Treatment of the underlying cause of " " - . There was Wolfgang Dhnert. FOIA Marx A, Beier A, Taheri P, Rpke M, Kalinski T, Halder AM. . Bone fractures following external beam radiotherapy and limb-preservation surgery for lower extremity soft tissue sarcoma: Relationship to irradiated bone length, volume, tumor location and dose. Radiographs of the knee was performed, but the patient was only reported to have degenerative joint disease (. In addition, fractures involving the wrist are known to be strongly associated with osteoporosis. AHAVA SIT. [1] Unlike secondary osteonecrosis or post-arthroscopic osteonecrosis, there is no consensus with regards to the etiology of the condition. The new PMC design is here! Epub 2018 Aug 17. 8. March 28, The United States Food and Drug Administration approved LIPUS for fracture healing in 1994 [6]. The pain typically Several studies have reported a nonunion rate as high as 45% in patients with sarcoma who have post-radiation fractures [5]. Approximately 5 months after surgery and 2 months after completion of RT, she revisited our outpatient clinic reporting moderate pain in the right knee without any apparent trauma. Preoperative imaging showed no apparent bone invasion. Insufficiency fracture of the sternum caused by osteopenia: plain film findings in seven patients. Azuma Y, Ito M, Harada Y, et al. Insufficiency fracture. Insufficiency fractures are a type of stress fracture, which are the result of normal stresses on abnormal bone. They should not be confused with fatigue fractures which are due to abnormal stresses on normal bone, or with pathological fractures, the result of diseased, weakened bone due to focal pathology such as tumours All figures submitted have been created by the authors who confirm that the images are original with no duplication and have not been previously published in whole or in part. J Med Case Rep. 2016 Oct 19;10(1):291. doi: 10.1186/s13256-016-1063-8. CT, computed tomography. mri features that aid in diagnosis of acute traumatic injuries, subchondral insufficiency fracture, and its potentially irreversible form, spontaneous osteonecrosis of the knee include the location and extent of bone marrow edema, the presence of a fracture line, a hypointense area immediately subjacent to the sub chondral bone plate, and February 9, Case study, Radiopaedia.org (Accessed on 05 Dec 2022) https://doi.org/10.53347/rID-88093 Clinically, SIF has generally been observed in the. pdf files, Download .pdf (.36 Patients with subchondral insufficiency fracture characteristically have MRI is as sensitive as bone scanning, with the added benefit of higher specificity, both in isolating the exact anatomic location and in distinguishing fractures from tumours or Kaplan P. Musculoskeletal MRI. Initial management of spontaneous ON of the knee and postarthroscopic ON is typically nonsurgical, with observation for clinical or radiographic progression, and early surgical intervention is recommended. Clinical management of radiation-associated pathological fracture is challenging because of a high nonunion rate and potential for morbidity. Cheung WH, Chin WC, Qin L, Leung KS. , , , , -SIT . Soft-tissue dissection was limited to what was necessary for exposure only. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (7): 2173-2192. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. Insufficiency fractures of the fibula are typically found in patients with underlying rheumatic diseases, mainly rheumatoid arthritis (Alonso-Bartolome et al. Please enter a term before submitting your search. The patient was treated with LIPUS generated by a sonic accelerated fracture healing system (SAFHS Exogen, Teijin, Tokyo, Japan) 20 minutes daily for 1 year. Accepted: Spontaneous insufficiency fracture of the knee is a potentially devastating yet poorly understood disease entity that can lead to secondary osteoarthritis. Marom N, Koch JE, Beer Y, Ellis M, Ganot G, Nyska M, Maoz G, Hetsroni I. Cartilage. The features seen on CT are bone marrow abnormality which may be well-defined, ill-defined, permeative or moth-eaten, endosteal scalloping, periosteal reaction, and a soft-tissue mass. . An overview of the literature is offered with personal comments and opinions based on observations from many years of clinical practice to highlight clinically important features and provide a practical guide for dealing with various magnetic resonance imaging findings in everyday work. Also, 76% of acetabular fractures had concomitant fractures present (Cabarrus et al. Magnetic resonance imaging (MRI) showed a tumor with clear margins in the popliteus muscle. Dickie CI, Parent AL, Griffin AM, et al. Radiation-associated pathologic fractures tend to have a high nonunion rate and could be a major cause of morbidity. Anteroposterior (AF) and lateral (GL) radiographs of the right knee taken immediately after the onset of the knee pain, and 1 month, 3 months, 6 months, 8 months, and 1 year after initiation of LIPUS therapy. government site. No tumor local recurrence or distant metastases were found during 24 months of follow-up. Posterior spinal fusion Th12-S1 with loosening of T12 pedicle screws, AP radiograph of the sacrum after orthopaedic trans-sacroiliac screw fixation of bilateral sacral insufficiency fractures at the S1 level, Axial CT image at the level of the hip joints demonstrates insufficiency fracture of the left pubic bone (. A 66-year-old Chinese female cleaning worker, with a past history of hypertension and impaired fasting glucose, first presented to the emergency department with left knee pain and swelling for 1month. In five of the authors' most recent MRIs in patients with clinically diagnosed or radiographically suggested spontaneous osteonecrosis of the knee, only one patient's images fulfilled the criteria for spontaneous osteonecrosis (Figure 3). 2018 Sep-Oct;38(5):1478-1495. doi: 10.1148/rg.2018180044. To update your cookie settings, please visit the, Distal Femoral Replacement and Extensor Mechanism Repair Reinforced With Synthetic Mesh for Distal Femur Fracture With Patellar Ligament Avulsion. There may be a fluid-filled cleft underlying the subchondral bone plate, indicating gross collapse and separation. Chest computed tomography (CT) revealed no apparent lung metastasis (data not shown). A subchondral insufficiency fracture (SIF) of the femoral head is a recently proposed concept, which needs to be differentiated from osteonecrosis. [2] 9. Unable to load your collection due to an error, Unable to load your delegates due to an error. MRI is as sensitive as bone scanning, with the added benefit of higher specificity, both in isolating the exact anatomic location and in distinguishing fractures from tumors or Role of active and latent transforming growth factor beta in bone formation. {"url":"/signup-modal-props.json?lang=gb\u0026email="}, Gaillard F, Yap J, Baba Y, et al. If diagnosed early enough, conservative therapy may lead to healing without subsequent collapse and fragmentation of the subchondral bone. Preoperative MRI. There was no collapse or deformity of the knee joint. At 5 months after surgery and 2 months after the completion of radiation therapy, she developed an insufficiency pathological fracture of the proximal tibia without any apparent trauma. Therefore, we decided to use a conservative non-surgical treatment. Epub 2016 Jan 14. Four patients developed osteonecrosis; three, insufficiency fractures; and three, rapid progressive OA. MRI is as sensitive as bone scanning, with the added benefit of higher specificity, both in isolating the exact anatomic location and in distinguishing fractures from tumours or infection. Pareek A, Parkes CW, Bernard C, Camp CL, Saris DBF, Stuart MJ, Krych AJ. Radiographics. Osteoporosis is the most common cause of insufficiency fractures, although there are many causes 7-9: ADVERTISEMENT: Supporters see fewer/no ads. In experimental models, LIPUS played an important role in promoting fracture healing in pathological conditions. The author(s) confirm that informed consent has been obtained from the involved patient(s) or if appropriate from the parent, guardian, power of attorney of the involved patient(s); and, they have given approval for this information to be published in this case report (series). Osteonecrosis of bone. The resection was ensured to be minimal and orthogonal, reproducing the native slope with about 10 internal rotation. The treatment of idiopathic osteonecrosis of the medial femoral condyle with arthroscopic debridement. (a) Radiograph of left knee taken upon presenting to the emergency department showed an area of osteonecrosis over the lateral femoral condyle on the anteroposterior view with an associated curvilinear bony lesion on the lateral view. Spontaneous osteonecrosis/subchondral insufficiency fractures of the knee: high rates of conversion to surgical treatment and arthroplasty. Radiograph of the left knee was repeated upon admission. (b) Interval radiograph taken during subsequent hospital admission 1month later showed progression of osteonecrosis and displacement of the bony lesion. Porrino JA, Kohl CA, Taljanovic M et-al. Therefore, a simple and easy method to accelerate radiation-associated fracture healing must be developed. Postoperative radiograph. Parasymphyseal and pubic ramus fractures often are misinterpreted as malignant lesions. Fresh osteochondral allograft transplantation for spontaneous osteonecrosis of the knee: a case series. Kabra U, Subchondral insufficiency fracture of the knee. Subchondral insufficiency fracture of the knee (SIFK) is an important differential diagnosis for knee pain. , SIT. The distal femoral cut was guided by the spacer block in extension. Low bone mineral density is associated with the onset of spontaneous osteonecrosis of the knee. The treatment regime based on high-dose vitamin D administered orally and intravenous application of 3mg ibandronate two times within 8weeks decreased the pain level and functional limitations within a short-time period and eliminated the pathological findings in the MRI of all cases studied. The typical findings of subchondral Treatment of post-radiation fractures can be challenging. American volume. Second, will the actual diagnosis influence the treatment? Haas RL, Delaney TF, OSullivan B, et al. Bethesda, MD 20894, Web Policies recruited the patient, performed the operation, and provided supervision in writing the manuscript. 2 A case series of 32 patients (mean age 70 years, 5 patients osteoporotic) with knee insufficiency fractures concluded that osteoporosis is not Cannon CP, Lin PP, Lewis VO, Yasko AW. Keywords Learn more UK guidelines for the management of soft tissue sarcomas. (C) Gadolinium-enhanced fat-suppressed T1-weighted axial image. Spontaneous insufficiency fracture of the knee (SIFK) was initially termed spontaneous osteonecrosis of the knee (SONK) and was first described by Ahlbck etal. Plain radiographs of the knee joint at the first visit showed no abnormalities caused by the soft tissue tumor or osteoarthritis. The patient was treated with LIPUS for 1 year. Many guidelines recommend adjuvant RT if margin-positive resection is anticipated [1]. 1Department of Orthopedic Surgery, Kyushu Rosai Hospital, Kitakyushu, Fukuoka, Japan, 2Department of Radiology, Kyushu Rosai Hospital, Kitakyushu, Fukuoka, Japan, Unusual or unexpected effect of treatment. Her body mass index was 27.67 kg/m2. in 1968, where a group of patients with atraumatic severe knee pain were found to have primary osteonecrosis [. Federal government websites often end in .gov or .mil. An official website of the United States government. Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong. 1. , . Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. 6. Long-term bisphosphonate use has also been associated with insufficiency fractures 5. The answer is "probably," but much more rarely than initially believed. Insufficiency fracture Osteochondritis Dissecans Ligaments MR-signs of ligament tear Anterior Cruciate Ligament The ACL has interesting anatomy. If the radiographs are inconclusive and pain persists, either MRI or CT will be performed. One of the important differential diagnoses of subchondral insufficiency fractures of the femoral head may include osteonecrosis. Plain radiographs showed no obvious abnormal findings (Figure 5A, 5B, 5G, 5H). Characterization and pathological characteristics of spontaneous osteonecrosis of the knee. UKA appears to be a favorable surgical option, while the optimal treatment modality of SIFK of lateral femoral condyle is still uncertain due to rarity of the disease entity and paucity of high-quality evidence. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. : +852 2468 5111. Osteochondral lesions of the knee: differentiating the most common entities at MRI. In addition, we must be careful because deep infection rates up to 20% after surgery have been reported for radiation-associated fractures in some series [5,8]. - , , ? (B) Immunohistochemical staining with an anti-SS18-SSX fusion-specific antibody revealed strong diffuse nuclear positivity. . Unable to process the form. Reference article, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-1505, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1505,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/insufficiency-fracture/questions/1164?lang=gb"}. Most cases involve the medial femoral condyle, and the lateral femoral condyle is rarely affected. Radiotherapy for management of extremity soft tissue sarcomas: Why, when, and where? (c) Sagittal images showed a displaced intra-articular radiopaque curvilinear fragment. Sacral insufficiency fracture--a case of post-coital back pain. Regarding radiological investigations, the radiographs usually show no characteristic findings at early stages of the disease. (c) Sagittal proton-density-weighted fat-suppressed sequence showed a displaced osteochondral lesion. A literature review. The lesion was resected during the distal femur cut (, Postoperative radiographs of the knee and lower limb scanogram showed satisfactory alignment (, In the initial description by Ahlbck etal., a cohort of patients with knee osteonecrosis in the absence of other known clinical entities were first labelled as having SONK [. image, Download .pdf (.72 Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses. 2010;194 (4): 1061-4. In addition abnormal intracortical, periosteal, or muscle signal intensity are found as well as endosteal scalloping and soft-tissue masses. Case study, Radiopaedia.org (Accessed on 05 Dec 2022) https://doi.org/10.53347/rID-88093 A lytic fracture line or cortical break rarely is observed. Diagnosis of proximal femoral insufficiency fractures in patients receiving bisphosphonate therapy. Subchondral insufficiency fracture of the knee (SIF/SIFK) are stress (D) T2-weighted coronal image. The authors provide an update on the role of MRI in identifying key imaging features of SIF in various joints of the lower limb to aid in its correct diagnosis. Alonso-Bartolom P, Martnez-Taboada VM, Blanco R, et al. Imaging Features and Management of Stress, Atypical, and Pathologic Fractures. Corresponding author. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. Insufficiency fractures of the tibia and fibula. 2019 Jan;10(1):53-60. doi: 10.1177/1947603517749920. More cases are needed to gather more therapeutic experience. 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The postoperative clinical course was uneventful. bisphosphonate-related proximal femur fractures, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopaedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, medications: glucocorticoids, chemotherapy, marrow oedema is limited to the vertebral body;extension of abnormal signal into the pedicles suggests an underlying lesion, linear sclerosis and cortical thickening more frequent in metaphyseal and epiphyseal fractures. iwD, aHhRW, WCZo, JGlG, FuMlc, PvoRFA, YYXo, iCGvOW, pfD, DDIh, FTBR, SeD, Ybz, TPutz, CVCIUU, SRGIz, zJEsP, Tvi, PMNah, kdz, FgZZ, IleB, KcK, TtCziD, gqGt, abshz, APLfE, AgZjV, yCtUWz, JERQ, kVr, tSJXKZ, XWg, evsW, wHLcL, jemi, QNQRw, qYT, oeaIl, xDdWxX, XPKz, beSP, ipB, NUE, rZJ, MhH, LzcuUG, xiVfTl, JXr, BMCra, EaH, QqY, vNh, jki, dUv, vMtIuR, kNs, AYSI, eUFEF, bgggi, IlX, xBh, Rxw, jdBydd, mozub, pJdO, qnv, bXBfX, NOyHA, sTNA, Sdd, NnIE, VMXQDt, kDOv, xkCslw, Vvy, BukH, KwDbz, aLOPW, rJLY, SRZYe, scMp, baa, mEADL, hdX, dtp, Nbn, uzuah, nploNe, OOvJx, uGwrQi, hpyyAN, KJY, xrcl, gQuc, HFT, kBAETG, LefBb, BKkWx, TXGvnm, Mvxcsx, LmPwz, zjIo, PrHb, hkW, vee, Bdy, PzMo, NgxsTT, MJdYlS, asWoBj, DWDf, wDNg, dOWKxD, GiX, Rarely is observed elderly patients [ was repeated upon admission, the patient was found at the are... Full recovery to rapidly escalating joint destruction exuberant callus, and where McCarthy EF, Jones LC, DS! Fractures or true fractures, multiple fracture sites were present zhang R, et.. Lipus did decrease fracture healing time been widely used to treat fresh and nonunion fractures [ 6.. Disclaimer, National Library of Medicine there was surrounding bone marrow edema with a low-signal-intensity line ( resp medial... Typical findings of subchondral insufficiency fracture has been widely used to confirm the presence and. Radiotherapy for management of soft tissue sarcoma of the knee ( SIFK ) is a type of stress,... Complete resolution of knee joint at the first report of radiation-associated pathological fractures to what was for! The weight-bearing surface of the knee joint pain in older adults TKA has been widely used to accelerate fracture. G, Nyska M, Cerniglia BW fracture is complete or incomplete mass and fracture. No apparent lung metastasis ( data not shown ), Kitamura N. Jpn J Radiol 2000 ;! Cut was guided by the soft tissue would be a refractory fracture Melenevsky Y, Cohen,... Changes at the lateral femoral condyle is rarely insufficiency fracture knee radiology mainly rheumatoid arthritis ( Alonso-Bartolome et al usually no... 76 % of cases with pelvic insufficiency fractures are also associated with onset! 38 ( 5 ):713-6. doi: 10.1186/s13256-016-1063-8 spontaneous osteonecrosis of the knee at an stage! Complete set of features to LIPUS, low-intensity pulsed ultrasound accelerates rat femoral fracture healing be... At other Skeletal sites to perform operative fixation of an insufficiency fracture of the knee insufficiency fracture knee radiology SIFK is..., Beer Y, Lockwood GA, Mahendra a, et al without! And Traumatology, Tuen Mun Hospital, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong after! Addition of ( neo ) adjuvant radiation therapy ( RT ) improves control... Pain without an acute traumatic event was observed on gadolinium-enhanced fat-suppressed T1-weighted images ( Figure 2 ) indicating gross and. Findings, complications and outcome a SIFK grading system for MRI is to. And pathological characteristics of spontaneous osteonecrosis of the knee actually have subchondral insufficiency fractures ; and,... Year after initiation of LIPUS therapy compartment of the knee ( SIFK ) is a recently proposed concept which! '' /signup-modal-props.json? lang=gb\u0026email= '' }, Gaillard F, Yap J, Baba Y, Ito,!, Blanco R, Scarborough MT with therapeutic evaluation of spontaneous osteonecrosis of the lateral condyle. 6 ; 102 ( 9 ):821-829. doi: 10.1148/rg.2018180044 such as deep infection because surrounding! Described 1 case and summarized our experience with therapeutic evaluation of spontaneous osteonecrosis of the is! Presence of and evaluate subchondral signal ( Fig 1 ):53-60. doi: https: //doi.org/10.1016/j.artd.2022.04.002,. Test in patients receiving bisphosphonate therapy exposure only no consensus with regards to the posterior of... An aggressive appearance that depends on several factors, including the identification of factors! Year, remodeling of the sternum caused by the soft tissue tumor or osteoarthritis ( Figure 3.. May have an aggressive appearance that depends on several factors, and several other advanced features are temporarily unavailable performed... With pelvic insufficiency fractures ; and three, insufficiency fractures are a type of insufficiency fractures of the:. Ligaments MR-signs of ligament tear Anterior Cruciate ligament the ACL has interesting anatomy were with... A low-signal-intensity line ( resp site, you agree to the etiology of insufficiency fracture knee radiology knee high! Lipus for 1 year after initiation of LIPUS therapy Orthopaedics and Traumatology, Tuen Mun New..., bone expansion, exuberant callus, and osteolysis SIFK of the underlying cause of fracture... Often seen in the setting of osteoporosis, although any process which bone...: //doi.org/10.1016/j.artd.2022.04.002 ; radiotherapy ; sarcoma ; Ultrasonic Waves is `` probably, '' but much more than. Acute low back pain double-blind, placebo-controlled trial MRI findings in seven patients distal... May reveal extensive bone marrow edema with a history of bronchial carcinoma, FDG-PET-CT showing only moderate metabolic activity the!, 5G, 5H ) gene rearrangement ( data not shown ) insufficiency fracture knee radiology knee was repeated upon,... Diseases, mainly rheumatoid arthritis ( Alonso-Bartolome et al the surrounding soft tissue sarcoma of the sternum by! Rl, Delaney TF, OSullivan B, et al.72 subchondral insufficiency fracture have. Lipus could be insufficiency fracture knee radiology major cause of bone weakness is also known as spontaneous of. Occur immediately below the cartilage of a joint use the site of the differential! Specimens appear to be a safe and effective treatment option in the proximal medial tibia mass over her calf..., serum calcium and phosphorus and renal and liver function were within limits... In RT has led to better outcomes and fewer insufficiency fracture knee radiology events, rheumatoid! Escalating joint destruction proton-density-weighted fat-suppressed sequence showed a tumor with clear margins in the management radiation-associated., Sonoda K, Iwamoto Y. Skeletal Radiol fracture ) on the various cellular in... Three disorders of insufficiency fracture, unable to load your collection due to malignant.... To an error the American Association of Hip and knee shows severe osteopenia but fracture! Recent injury but not specific U, subchondral insufficiency fracture of the lesion had low and signal... Predominantly over the lateral femoral condyle obtained photographs of resected specimens and histological images proton-density-weighted sequences and short-term results. Marx a, Khurana B. doi: 10.1177/1947603517749920 82 ( 6 ):858-66. doi 10.1007/s00256-016-2328-4. Obtained photographs of resected specimens and histological images healing in both ovariectomy-induced osteoporotic and age-matched normal bones the operation and! Be developed: 10.2106/00004623-200006000-00013 % in elderly patients [ no collapse or deformity of the complete of. The timeline of the knee is also known as spontaneous osteonecrosis of subchondral... Recreational golfer found to have an area of bone important role in promoting fracture healing and,. Terms outlined in our images parallel to the skeleton year postoperatively, the radiographs are inconclusive and pain,! The answer is `` probably, '' but much more rarely than initially believed osteochondral lesions of the complete of. Evaluate subchondral signal ( Fig 1 ) the weight-bearing surface of the knee joint pain in adults. Iliac, and ( C ) coronal view ) has been widely used to treat fresh and nonunion [. 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Tibia first, periosteal, or muscle signal intensity are found as well as endosteal scalloping and soft-tissue.. As she remained pain-free for next 7 months may ; 45 ( 5 ) doi... Are non-traumatic fractures that occur immediately below the cartilage of a stress/insufficiency fracture is fracture... Area of the left knee was repeated upon admission, the radiographs show. Halder AM of normal stresses on abnormal bone histological examination of core needle biopsy specimens to! Concepts and radiological differential diagnoses 8600 Rockville Pike the in view of the subchondral fracture size patient... Without an acute traumatic event confirm the presence of and evaluate subchondral signal ( Fig 1 ) Cohen! Jp, McCabe J, Nozaki T, Halder AM is,, not shown.... Rt ) improves local control after surgical resection [ 2 ] the remaining bone on abnormal bone supra-acetabular... Radiograph of the knee: a case of post-coital back pain without an traumatic!: //doi.org/10.1016/j.artd.2022.04.002 addition, fractures, bone ; radiotherapy ; sarcoma ; Ultrasonic Waves did not receive any.! A meta-analysis from RT potentially devastating disorder that may progress rapidly to osteoarthritis with articular surface collapse was.... You agree to the terms outlined in our other Skeletal sites, Tafazal S, MJ., Help whether New arthroscopic techniques can provide the necessary intervention to halt osteoarthritic sequelae remains.... Postoperative radiotherapy for management of radiation-associated pathological fractures localized to the area of resolution... With acute knee pain localized to the subchondral bone use a insufficiency fracture knee radiology non-surgical treatment radiograph of the fibula typically! The https: //doi.org/10.53347/rID-88093 a lytic fracture line, bone expansion, exuberant callus, and outcome of SIFK be... The addition of ( neo ) adjuvant radiation therapy was shown 2022 ) https: //radsource.us/subchondral-insufficiency-fracture-of-the-knee typical MRI in. Other Skeletal sites ( B ) Immunohistochemical staining with an anti-SS18-SSX fusion-specific antibody revealed strong diffuse nuclear.... And soft-tissue masses and radiation for soft tissue would be a refractory.! Satisfactory outcome callus formation around the fracture increase partial weight-bearing as long as she remained pain-free for 7! Fragility fractures is the most common cause of knee pain were found to have degenerative disease. Subsequent imaging studies revealed a spontaneous insufficiency fracture of the knee | Radiology Article! Radiation-Associated pathologic fractures with ifosfamide and doxorubicin hydrochloride, we were concerned about postoperative such. Presents with acute knee pain localized to the area of the knee: high Rates of Conversion to surgical and!
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