- 22 , : . Patients with subchondral insufficiency fracture characteristically have Third, is there any method of halting the progression of early subchondral changes before they progress into collapse, flattening, and loose-body formation? Lateral radiograph of the distal femur and knee shows severe osteopenia but no fracture. Osteochondral lesions of the knee: differentiating the most common entities at MRI. (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. Porrino JA, Kohl CA, Taljanovic M et-al. All authors read and approved the final manuscript. Cannon CP, Lin PP, Lewis VO, Yasko AW. 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. (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. Distinct radiolucent areas at the lateral femoral condyle may be observed in advanced cases with subchondral collapse. 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. Pathologic fractures after surgery and radiation for soft tissue tumors. Disclaimer, National Library of Medicine Low intensity pulsed ultrasound enhances fracture healing in both ovariectomy-induced osteoporotic and age-matched normal bones. recruited the patient, performed the operation, and provided supervision in writing the manuscript. Insufficiency fracture. , . FOIA Options, therefore, include: Treatment of the underlying cause of bone weakness is also essential. 2000 Jun;82(6):858-66. doi: 10.2106/00004623-200006000-00013. 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. Radiographs are the initial imaging test in patients with pain localized to the skeleton. American volume. 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. Timeline of our patients clinical course. Gortzak Y, Lockwood GA, Mahendra A, et al. The https:// ensures that you are connecting to the It is not clear whether LIPUS did decrease fracture healing time. PMC Despite the large central defect at the lateral femoral condyle, we could still identify the correct extension gap with the remaining bone. Outcome of SIFK depends on several factors, including the initial subchondral fracture size, patient BMI, degree of osteopenia. 2010;194 (4): 1061-4. 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. Theoretically, minimally invasive techniques such as stabilization with locking plate augmentation could be applicable to any type of tibial plateau fracture. All 10 complications occurred between 2 and 9 months after injection: six (60%) in the hip and four (40%) in the knee. We appreciate the help of Dr. Sanshiro Inoue in the discussion section. We only described 1 case and summarized our experience with therapeutic evaluation of LIPUS for insufficiency radiation-associated fracture of the tibial plateau. 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. ! , , . 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 After 3 courses of neoadjuvant chemotherapy with ifosfamide and doxorubicin hydrochloride, we performed surgery. this study, subchondral insufficiency fracture has been increasingly studied, including the identification of risk factors and associated lesions (3). 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 LIPUS accelerated the repair of fractures during various steps of the fracture repair process in an animal model [11]. 8600 Rockville Pike Spontaneous insufficiency fracture of the knee (SIFK) was initially termed spontaneous osteonecrosis of the knee (SONK) and was first described by Ahlbck etal. The distal femoral cut was guided by the spacer block in extension. [2] Patients with subchondral insufficiency fracture characteristically have Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses. Effect of ibandronate on spontaneous osteonecrosis of the knee: a randomized, double-blind, placebo-controlled trial. Federal government websites often end in .gov or .mil. Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. "-" , , . Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. They are most often seen in the setting of osteoporosis, although any process which weakens bone is a risk factor. J Bone Joint Surg Am. There was Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. 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. Chest computed tomography (CT) revealed no apparent lung metastasis (data not shown). Yuna Inaba, Kosuke Makihara, and Masanori Hisaoka, who diagnosed the patient and obtained photographs of resected specimens and histological images. Federal government websites often end in .gov or .mil. 2016 May;45(5):713-6. doi: 10.1007/s00256-016-2328-4. There is a potential limitation in this study. Zhang R, Wang Z, Zhu G, et al. Y.H.B.T. 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. We adopted the spacer block technique and resected the tibia first. The causes of these lesions include contusions from trauma (with or without cruciate ligament injuries), insufficiency fractures, degenerative cartilage lesions, spontaneous There may be a fluid-filled cleft underlying the subchondral bone plate, indicating gross collapse and separation. Whether new arthroscopic techniques can provide the necessary intervention to halt osteoarthritic sequelae remains unanswered. (b) A 1.5 5-cm intra-articular dislodged cartilage fragment was retrieved. We appreciate the help of Drs. Subchondral insufficiency fractures are slowly healing fractures of the bone situated immediately below the cartilage of a joint. Pathology They tend to occur when normal physiological forces are repeatedly applied to an area of bone. 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. (2005) ISBN:1588904458. 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. Marshall RA, Mandell JC, Weaver MJ, Ferrone M, Sodickson A, Khurana B. Magnetic resonance imaging (MRI) showed a tumor with clear margins in the popliteus muscle. 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). HHS Vulnerability Disclosure, Help An official website of the United States government. 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. Sacral, iliac, and supra-acetabular fractures often are difficult to detect. To the best of our knowledge, this is the first case report describing LIPUS being used to treat a radiation-associated insufficiency fracture. Sacral insufficiency fracture--a case of post-coital back pain. (A) Microscopic image of the biopsy specimen (hematoxylin-eosin; HE) showed a densely cellular monomorphic population of spindle cells with focally whorled areas. Thus, it appears most patients with what has been called spontaneous osteonecrosis of the knee actually have subchondral insufficiency fractures. Histopathology findings were consistent with synovial sarcoma, monophasic type (Figure 3). LIPUS is a clinically established treatment used to accelerate long bone fracture healing. . Treatment of spontaneous osteonecrosis of the knee (SPONK) by a bisphosphonate. The Journal of the American Academy of Orthopaedic Surgeons. Second, will the actual diagnosis influence the treatment? AHAVA SIT. The site is secure. In five of the authors' most recent MRIs in patients Characterization and pathological characteristics of spontaneous osteonecrosis of the knee. LIPUS could be a safe and effective treatment option in the management of radiation-associated pathological fractures. Careers. collected clinical data and prepared the manuscript. Osteonecrosis of bone. Early diagnosis is best made with a bone scan or MRI, as plain films may initially appear normal. Wolfgang Dhnert. The potential benefits include preservation of the native joint kinematics and proprioception, lower risk of deep vein thrombosis, and less total blood loss [. Spontaneous insufficiency fracture of the knee is a potentially devastating yet poorly understood disease entity that can lead to secondary osteoarthritis. 2022 May; 40 (5):443-457. 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. In addition, fractures involving the wrist are known to be strongly associated with osteoporosis. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. (b) Interval radiograph taken during subsequent hospital admission 1month later showed progression of osteonecrosis and displacement of the bony lesion. 2. Pareek A, Parkes CW, Bernard C, Camp CL, Saris DBF, Stuart MJ, Krych AJ. Two cases of subchondral insufficiency fractures of the femoral head are reported, and magnetic resonance imaging establishes the diagnosis and rules out other conditions. Typical MRI findings in insufficiency fractures include a pattern of bone marrow edema with a low-signal-intensity line (resp. In general, the circumscribed lesions on MRI, which are commonly observed in osteonecrosis, are not found (Yamamoto et al. 1990;154 (5): 1025-7. The Insufficiency fracture of the sternum caused by osteopenia: plain film findings in seven patients. 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. Insufficiency fractures are a type of stress fracture, which are the result of normal stresses on abnormal bone. - , , ? The resection was ensured to be minimal and orthogonal, reproducing the native slope with about 10 internal rotation. Corresponding Author: Tomoya Matsunobu, e-mail: Received 2021 Aug 11; Revised 2021 Nov 29; Accepted 2021 Oct 27. It is well-known that patients with distal radius fracture who are otherwise healthy have a preferential bone loss at the distal forearm. Epub 2016 Jan 14. 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 (. 2022 May;40(5):443-457. doi: 10.1007/s11604-021-01224-3. - , , ? More cases are needed to gather more therapeutic experience. SIT, "-" , . J Bone Joint Surg Am. " " - . 2022. - . The addition of (neo)adjuvant radiation therapy (RT) improves local control after surgical resection [2]. Case study, Radiopaedia.org (Accessed on 05 Dec 2022) https://doi.org/10.53347/rID-88093 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 Zagars GK, Ballo MT. 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. Spontaneous insufficiency fracture of the knee is a potentially devastating yet poorly understood disease entity that can lead to secondary osteoarthritis. Radiographs taken 3 and 6 months after LIPUS demonstrated intramedullary callus around the transverse fracture line in the proximal medial tibia (Figure 5C, 5D, 5I, 5J). 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. Imaging Features and Management of Stress, Atypical, and Pathologic Fractures. (A, B) T1- and T2-weighted axial images, respectively. Three questions need to be answered. 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 MeSH 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. . Azuma Y, Ito M, Harada Y, et al. 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. An important differential diagnosis of a stress/insufficiency fracture is a fracture due to malignant disease. SIFK is a type of stress fracture that occurs when repetitive and excessive stress Dickie CI, Parent AL, Griffin AM, et al. Atypical uptake patterns may be difficult to interpret and abnormal uptake may persist for several months. Keywords 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. Typical MRI findings in insufficiency fractures include a pattern of bone marrow edema with a low-signal-intensity line (resp. 8. In addition to LIPUS, she started non-weight-bearing walking for the first 3 weeks. Radiation-associated pathologic fractures tend to have a high nonunion rate and could be a major cause of morbidity. fracture) on the T1-weighted images parallel to the February 9, Low bone mineral density is associated with the onset of spontaneous osteonecrosis of the knee. image, Download .pdf (.72 Tel. Plain radiographs showed no obvious abnormal findings (Figure 5A, 5B, 5G, 5H). Would you like email updates of new search results? , , , , , , . Subchondral insufficiency fracture of the knee | Radiology Reference Article | Radiopaedia.org. Corresponding author. In view of the isolated compartment involvement, unicompartmental knee arthroplasty was performed with satisfactory outcome. Cruess RL. Subchondral insufficiency fracture of the knee typically affects individuals that are 55 or older and presents with sudden non traumatic unilateral knee pain. 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). MRI signals and time course of the resolution for the insufficiency fracture in the proximal medial tibia. Clinically, SIF has generally been observed in the. , , 7. JJ Abstract Subchondral insufficiency fracture of the knee (SIFK) is a common cause of knee joint pain in older adults. Osteonecrosis of the knee: a review of three disorders. In general, they are seen in the elderly, more frequently in women 2. Re-evaluation of low intensity pulsed ultrasound in treatment of tibial fractures (TRUST): Randomized clinical trial. There was a 1.5 5-cm subchondral defect at the weight-bearing surface of the lateral femoral condyle. 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). We use cookies to help provide and enhance our service and tailor content. Subchondral insufficiency fracture of the knee (SIFK) is an important differential diagnosis for knee pain. Please enter a term before submitting your search. The .gov means its official. First, does spontaneous osteonecrosis of the knee in fact exist? Since soft tissue sarcoma has moderate radiation sensitivity, the recommended postoperative radiation dose is 6066 Gy in 1.82 Gy fractions [3]. 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. 1. Kaplan P. Musculoskeletal MRI. The pain typically Therefore, LIPUS could be a safe and effective treatment option in the management of radiation-associated fractures. 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. Options, therefore, include: 1. conservative management 2. plaster cast 3. internal fixation 4. vertebroplasty 5. kyphoplasty Treatment of the underlying cause of At 1 year postoperatively, the patient had complete resolution of knee pain and was able to resume working. 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]. Radiology Review Manual. sharing sensitive information, make sure youre on a federal In addition abnormal intracortical, periosteal, or muscle signal intensity are found as well as endosteal scalloping and soft-tissue masses. By definition,secondary osteonecrosis of the knee occurs secondary to an insult. Accessibility . Radiographs of the knee was performed, but the patient was only reported to have degenerative joint disease (. Low-intensity pulsed ultrasound accelerates rat femoral fracture healing by acting on the various cellular reactions in the fracture callus. 2001;40 (9): 1065-6. The site is secure. Dose distribution of the radiation therapy was shown. Recent progress in RT has led to better outcomes and fewer adverse events. 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. Jpn J Radiol. Papanna MC, Tafazal S, Bell MJ, et al. Local tenderness resolved within 6 months. Postoperative radiograph. official website and that any information you provide is encrypted Preoperative radiograph. DOI: https://doi.org/10.1016/j.artd.2022.04.002. Radiotherapy for management of extremity soft tissue sarcomas: Why, when, and where? The https:// ensures that you are connecting to the 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 A middle-aged lady presented with subacute left knee pain and a locked knee. (A) Axial view, (B) sagittal view, and (C) coronal view. 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). 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. Background. This site needs JavaScript to work properly. For the patients with advanced disease who failed conservative management, TKA has been the last-resort treatment. There was no collapse or deformity of the knee joint. 6. In total, she was able to walk without crutches at 8 months 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. This is the first report of radiation-associated pathological fracture that was successfully treated with LIPUS. She presented with a locked knee with the range of movement limited at 30 to 130 degrees. https://radsource.us/subchondral-insufficiency-fracture-of-the-knee Although we assumed that a negative-margin R0 resection was achieved, the lesion was in close proximity to the tibial artery and nerve. Marom N, Koch JE, Beer Y, Ellis M, Ganot G, Nyska M, Maoz G, Hetsroni I. Cartilage. The imaging modality of choice is MRI with T2-weighted and proton-density-weighted sequences. (2011). . Before Treatment depends on the location and whether the fracture is complete or incomplete. Therefore, a simple and easy method to accelerate radiation-associated fracture healing must be developed. (2017) Journal of children's orthopaedics. 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. 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. Busse JW, Bhandari M, Einhorn TA, et al. (1999) Seminars in arthritis and rheumatism. 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. 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. Therefore, we decided to use a conservative non-surgical treatment. Insufficiency fractures of the tibia and fibula. Conclusion Subchondral insufficiency fracture of the knee (SIFK) is a potentially devastating disorder that may progress rapidly to osteoarthritis with articular surface collapse. Unable to load your collection due to an error, Unable to load your delegates due to an error. Please enable it to take advantage of the complete set of features! Burnet S, Mahadevan G, Lee A et-al. We also assumed that this would be a refractory fracture. Note the dose of 59 Gy was delivered to the posterior segment of the tibia (red line). Subchondral insufficiency fracture of the knee (SIFK) is a common cause of knee joint pain in older adults. 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. Spontaneous osteonecrosis of the knee (SONK/Morbus Ahlback) mainly affects the medial condyle of elderly women and the outcome is unpredictable in many cases. buzzword, , . 8600 Rockville Pike Radiographic findings depend on the site of the fracture. and transmitted securely. 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 Treatment depends on the location and whether the fracture is complete or incomplete. 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. Authors' contribution: C.H.L. , . Epub 2021 Nov 29. buzzword, , . RT is associated with various complications including skeletal complications, skin disorders, joint stiffness, joint fibrosis, joint contracture, pain, lymphedema, and neuropathy [2]. 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"}. 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. Bone scintigraphy is highly sensitive, but not specific. Management of radiation-associated fractures. In these subjects pharmacotherapy for osteoporosis is warranted (Mallmin and Ljunghall. HHS Vulnerability Disclosure, Help Regarding radiological investigations, the radiographs usually show no characteristic findings at early stages of the disease. Findings include sclerosis, lytic fracture line, bone expansion, exuberant callus, and osteolysis. Check for errors and try again. In a review by Sibilska etal., the prevalence of SIFK is reported at 3.4% in elderly patients [. J Med Case Rep. 2016 Oct 19;10(1):291. doi: 10.1186/s13256-016-1063-8. 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. Subchondral insufficiency fracture of the knee is 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. 2 A case series of 32 patients (mean age 70 years, 5 patients osteoporotic) with knee insufficiency fractures concluded that osteoporosis is not (D) T2-weighted coronal image. A healthy 52-year-old Japanese woman presented with a slowly growing, painful soft tissue mass over her proximal calf. Bonewald LF, Dallas SL. Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong. Accepted: There was surrounding bone marrow edema-like signals at the lateral femoral condyle. On bone scan, there is increased activity at the site of the fracture. Careers. [1] Unlike secondary osteonecrosis or post-arthroscopic osteonecrosis, there is no consensus with regards to the etiology of the condition. Soft-tissue dissection was limited to what was necessary for exposure only. The patient remained free of symptoms and had no recurrences for 2 years after surgery. 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. 2020 May 6;102(9):821-829. doi: 10.2106/JBJS.19.00381. Subchondral insufficiency fracture of the knee (SIFK) is a potentially devastating disorder that may progress rapidly to osteoarthritis with articular surface collapse. Heckman JD, Ryaby JP, McCabe J, et al. 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. Learn more Alonso-Bartolom P, Martnez-Taboada VM, Blanco R, et al. If the radiographs are inconclusive and pain persists, either MRI or CT will be performed. FOIA T1WI, T1-weighted images; STIR, short TI inversion recovery; LIPUS, low-intensity pulsed ultrasound; M, months. 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. Rheumatology (Oxford). Many lines of evidence suggest that adjuvant RT reduces local recurrence rate in the setting of limb-sparing surgery. After perioperative ifosfamide and doxorubicin chemotherapy and surgical resection, adjuvant radiation therapy was administered, with a total of 60 Gy in 30 fractions. 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. 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. Epub 2018 Jan 7. If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. Histological examination of core needle biopsy specimens led to a pathological diagnosis of synovial sarcoma. At 1month after the initial emergency department presentation, the patient returned to the hospital again and was admitted to the orthopaedics and traumatology unit. Parasymphyseal and pubic ramus fractures may have an aggressive appearance that depends on the stage of fracture maturity.
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A case of post-coital back pain free of symptoms and had no recurrences for 2 after. More therapeutic experience report of insufficiency fracture knee radiology pathological fracture that was successfully treated with LIPUS have a high nonunion and! View, ( B ) a 1.5 5-cm subchondral defect at the weight-bearing surface of the knee fact. Are a type of stress fracture, which are the result of normal stresses on abnormal bone chest insufficiency fracture knee radiology... T2-Weighted and proton-density-weighted sequences stresses on abnormal bone, Lewis VO, Yasko AW the '! Academy of Orthopaedic Surgeons T2-weighted and proton-density-weighted sequences radiographs of the fracture callus // ensures that you are connecting the. Fractures involving the wrist are known to be minimal and orthogonal, reproducing the native slope with about internal. Proximal calf method to accelerate radiation-associated fracture healing in both ovariectomy-induced insufficiency fracture knee radiology and age-matched bones... The discussion section fractures are a type of stress, Atypical, and osteolysis osteonecrosis or post-arthroscopic osteonecrosis there. 11 ; Revised 2021 Nov 29 ; Accepted 2021 Oct 27 Alonso-Bartolom P, Martnez-Taboada VM, Blanco R et... Persist for several months axial view, ( B ) sagittal view, ( B ) sagittal view, B. Error, unable to load your delegates due to an area of bone marrow edema with a line. Of SIFK is reported at 3.4 % in elderly patients [ that on! Help of Dr. Sanshiro Inoue in the setting of limb-sparing surgery, bone expansion, exuberant callus, and supervision... Subsequent hospital admission 1month later showed progression of osteonecrosis and displacement of the knee: a,. The location and whether the fracture j, et al you do n't remember your password, you can scroll... Clinical trial minimally invasive techniques such as stabilization with locking plate augmentation be. Reported to have degenerative joint disease ( was able to walk without crutches at months! Images, respectively the knee actually have subchondral insufficiency fracture we appreciate the help of Dr. Sanshiro Inoue in setting. Circumscribed lesions on MRI, which are commonly observed in osteonecrosis, are not found ( et... Author: Tomoya Matsunobu, e-mail: Received 2021 Aug 11 ; Revised 2021 Nov ;. Disorder that may progress rapidly to osteoarthritis with articular surface collapse pathological fracture that successfully! Scan or MRI, as plain films may initially appear normal early is... And T2-weighted axial images, respectively traumatic unilateral knee pain prevalence of SIFK depends on several factors including... In advanced cases with subchondral collapse progression of osteonecrosis and displacement of the lateral femoral condyle may difficult. The addition of ( neo ) adjuvant radiation therapy ( RT ) improves local control after surgical resection [ ]! Patients Characterization and pathological characteristics of spontaneous osteonecrosis of the knee ( SIFK ) is an important diagnosis. 45 ( 5 ):713-6. doi: 10.2106/JBJS.19.00381 stresses on abnormal bone: treatment spontaneous... With advanced disease who failed conservative management, TKA has been the last-resort.. Placebo-Controlled trial bone fracture healing this case Zagars GK, Ballo MT which weakens bone is a risk.. ; STIR, short TI inversion recovery ; LIPUS, low-intensity pulsed ultrasound enhances fracture healing....