Subchondral fracture of the femoral head after acetabular fracture: a case report

Journal of Medical Case Reports

Yukihide Iwamoto¹  Kazuyuki Karasuyama¹  Masanobu Ohishi¹  Goro Motomura¹  Yasuharu Nakashima¹  Takuaki Yamamoto¹  Satoshi Hamai¹  Keiichiro Iida¹ 

[1] Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan

关键词: Post-traumatic osteoarthritis;    Subchondral fracture of the femoral head;    Collapse of the femoral head;    Acetabular fracture;   

Others  :  1180885
DOI  :  10.1186/1752-1947-8-447

 received in 2014-06-07, accepted in 2014-10-30,  发布年份 2014

【 摘 要 】

Introduction

Preventing post-traumatic osteoarthritis is a challenging problem following acetabular fracture. Progressive osteoarthritis is considered to be caused by an irregular articular surface of the acetabular roof or cartilage injury, but little is known about the pathogenesis of collapse of the femoral head after acetabular fracture. We report a case of post-traumatic osteoarthritis after acetabular fracture in which subchondral fracture of the femoral head contributed to the progressive collapse of the femoral head and osteoarthritis. To the best of our knowledge, there has been no previous report of subchondral fracture of the femoral head after acetabular fracture.

Case presentation

A 58-year-old Japanese man fell from a ladder. He was diagnosed with a left acetabular fracture, which was managed conservatively. He developed left coxalgia six months after injury and was seen at our institution one year after the onset of pain. The left acetabular fracture had fused, but his left femoral head had collapsed. The images at the time of injury showed a fracture of the acetabular roof, and an approximately 2mm step-off existed in the articular surface. Retrospective evaluation of the plain radiographs and computed tomography images showed that his femoral head had progressively collapsed. Our patient underwent total hip arthroplasty. Histopathologic findings demonstrated that the collapse of his femoral head was caused by a subchondral fracture of his femoral head.

Conclusion

Our experience with this case indicates that in addition to post-traumatic osteonecrosis, subchondral fracture may need to be considered in cases with progressive collapse of the femoral head after acetabular fracture.

【 授权许可】

   
2014 Iida et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Tornetta P 3rd: Non-operative management of acetabular fractures. The use of dynamic stress views. J Bone Joint Surg Br 1999, 81:67-70.
• [2]Tornetta P 3rd: Displaced acetabular fractures: indications for operative and nonoperative management. J Am Acad Orthop Surg 2001, 9:18-28.
• [3]Matta JM: Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 1996, 78:1632-1645.
• [4]Hammond BT, Charnley J: The sphericity of the femoral head. Med Biol Eng 1967, 5:445-453.
• [5]Konrath GA, Hamel AJ, Sharkey NA, Bay BK, Olson SA: Biomechanical consequences of anterior column fracture of the acetabulum. J Orthop Trauma 1998, 12:547-552.
• [6]Tannast M, Najibi S, Matta JM: Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am 2012, 94:1559-1567.
• [7]Judet R, Jude J, Letournel E: Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am 1964, 46:1615-1646.
• [8]Mont MA, Zywiel MG, Marker DR, McGrath MS, Delanois RE: The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg Am 2010, 92:2165-2170.
• [9]Yamamoto T: Subchondral insufficiency fractures of the femoral head. Clin Orthop Surg 2012, 4:173-180.
• [10]Hak DJ, Hamel AJ, Bay BK, Sharkey NA, Olson SA: Consequences of transverse acetabular fracture malreduction on load transmission across the hip joint. J Orthop Trauma 1998, 12:90-100.
• [11]Llinas A, McKellop HA, Marshall GJ, Sharpe F, Kirchen M, Sarmiento A: Healing and remodeling of articular incongruities in a rabbit fracture model. J Bone Joint Surg Am 1993, 75:1508-1523.
• [12]Bangil M, Soubrier M, Dubost JJ, Rami S, Carcanagues Y, Ristori JM, Bussiere JL: Subchondral insufficiency fracture of the femoral head. Rev Rhum Engl Ed 1996, 63:859-861.
• [13]Rafii M, Mitnick H, Klug J, Firooznia H: Insufficiency fracture of the femoral head: MR imaging in three patients. AJR Am J Roentgenol 1997, 168:159-163.
• [14]Yamamoto T, Bullough PG: Subchondral insufficiency fracture of the femoral head: a differential diagnosis in acute onset of coxarthrosis in the elderly. Arthritis Rheum 1999, 42:2719-2723.
• [15]Visuri T: Stress osteopathy of the femoral head. 10 military recruits followed for 5-11 years. Acta Orthop Scand 1997, 68:138-141.
• [16]Liebergall M, Mosheiff R, Low J, Goldvirt M, Matan Y, Segal D: Acetabular fractures. Clinical outcome of surgical treatment. Clin Orthop Relat Res 1999, 366:205-216.
• [17]Tonetti J, Ruatti S, Lafontan V, Loubignac F, Chiron P, Sari-Ali H, Bonnevialle P: Is femoral head fracture-dislocation management improvable: a retrospective study in 110 cases. Orthop Traumatol Surg Res 2010, 96:623-631.
• [18]Potter HG, Montgomery KD, Heise CW, Helfet DL: MR imaging of acetabular fractures: value in detecting femoral head injury, intraarticular fragments, and sciatic nerve injury. AJR Am J Roentgenol 1994, 163:881-886.