1/8. Subchondral insufficiency fracture of the femoral head and medial femoral condyle.This case report documents the clinical, radiographic, and histologic findings in a 69-year-old obese man, who had subchondral insufficiency fracture both in the femoral head and medial femoral condyle. On plain radiographs, both lesions underwent subchondral collapse. Magnetic resonance images of the left hip showed a bone marrow edema pattern with associated low-intensity band on T1-weighted images, which was convex to the articular surface. The histopathologic findings in the hip and knee were characterized by the presence of a subchondral fracture with associated callus and granulation tissue along both sides of a fracture line. There was no evidence of antecedent osteonecrosis. To our knowledge, this is the first case report to describe the multiple occurrence of collapsed subchondral insufficiency fracture.- - - - - - - - - - ranking = 1keywords = osteonecrosis (Clic here for more details about this article) |
2/8. Stress fracture in the medial femoral condyle. A case report.An 88-year-old woman complained of pain in the medial part of her knee for 5 weeks. Plain radiography was normal. Clinical and scintigraphic findings were suggestive of spontaneous osteonecrosis of the medial femoral condyle. magnetic resonance imaging showed a stress fracture of the medial femoral condyle. In 3 weeks pain had disappeared, confirming this diagnosis.- - - - - - - - - - ranking = 1keywords = osteonecrosis (Clic here for more details about this article) |
3/8. Unusual osteonecrosis of the femoral head misdiagnosed as a stress fracture.We report a case of femoral head osteonecrosis that originally was misdiagnosed as a femoral neck stress fracture by plain radiography and magnetic resonance imaging. The correct diagnosis was made using pinhole bone scintigraphy, which revealed a completely cold lesion of the entire femoral head, confirmed by histologic examination. The patient was treated with muscle pedicle bone grafting, and 3 months postoperatively, pinhole bone scintigraphy showed improved vascularity of the femoral head.- - - - - - - - - - ranking = 5keywords = osteonecrosis (Clic here for more details about this article) |
4/8. Free vascularized fibular graft: a versatile graft for reconstruction of large skeletal defects and revascularization of necrotic bone.The microvascular transfer of a fibular graft that was initially introduced for the treatment of massive bone loss in the appendicular skeleton has more recently found another useful application in the management of the osteonecrosis of the femoral head. Since 1989, we have successfully used the free vascularized fibula in two patients with segmental bone loss, one in the forearm and the other in the distal femur. We have also attempted revascularization of the femoral head in fifteen patients (eighteen hips) with osteonecrosis. Although our follow-up is short, the results have been encouraging and this method is now the treatment of choice in the early stages of the disease.- - - - - - - - - - ranking = 2keywords = osteonecrosis (Clic here for more details about this article) |
5/8. Femoral head preservation in non-united femoral neck fracture and head osteonecrosis in Cushing's disease.There have been few reports associating avascular necrosis of bone with Cushing's disease. patients with Cushing's disease and avascular necrosis of the femoral head usually receive total hip arthroplasty. However, hip prosthetic replacement in younger patients has been criticized due to a high incidence of component loosening. We report a case of successful femoral head preservation in non-united femoral neck fracture and head osteonecrosis in a 14-year-old girl with Cushing's disease (adrenocorticotropic hormone-secreting pituitary adenoma) who developed avascular necrosis of the right femoral head and pathologic fracture of the right femoral neck 2 years after the onset of hypercortisolism. Subtrochanteric valgus osteotomy was performed to preserve the femoral head after successful transsphenoidal surgery to remove pituitary microadenoma. At follow-up 10 years after the osteotomy, the femoral head had revascularized and the femoral neck fracture were united with much improvement of hip function. Dual energy X-ray absorptiometry scan of the right hip showed 0.86 SD from the normal bone densitometry. Aggressive femoral head preservation may be an effective alternative to treat this rare situation in a teenager.- - - - - - - - - - ranking = 5keywords = osteonecrosis (Clic here for more details about this article) |
6/8. Pathological fracture of the femur ten years after successful radiation therapy for metastatic breast cancer.We describe a case involving a 75-year-old woman presenting with a femur fracture 10 years after radiation therapy for metastatic breast cancer, which developed in the right femur. The lesion showed complete response with bone healing following radiation therapy; however, the patient sustained a femur fracture ten years later. Histological examination of the specimens obtained from the lesion revealed features of radiation osteonecrosis, but there was no histological evidence of tumor. To our knowledge, there has been no reported case of pathological fracture ten years after radiation therapy from radiation osteonecrosis rather than progression of the metastatic lesion. Late complications of radiation therapy should be considered with care, even when metastatic lesions demonstrate complete response to treatment.- - - - - - - - - - ranking = 2keywords = osteonecrosis (Clic here for more details about this article) |
7/8. Femoral reconstruction by vascularized bone transfer.Thirty-five patients with extensive femoral defects or recalcitrant nonunions were reconstructed by microvascular bone transfer with a follow-up period exceeding 12 months. The cause of bone defect included trauma, debridement for osteomyelitis, or tumor resection, and the cause of nonunion included trauma or postirradiation osteonecrosis. Sixty-nine percent of patients healed primarily, whereas 83% of patients ultimately progressed to union following secondary surgery. One patient who initially healed later required amputation for late graft fracture with nonunion; therefore, at final follow-up, 80% of patients were fully healed. Vascularized bone transfer merits strong consideration for reconstruction of atypical and particularly difficult femoral nonunions.- - - - - - - - - - ranking = 1keywords = osteonecrosis (Clic here for more details about this article) |
8/8. Insufficiency fractures of the medial femoral condyle.We report six cases of insufficiency fractures of the medial femoral condyle responsible for severe mechanical pain in the medial knee compartment in the absence of any identifiable precipitating factor. Suggestive changes were seen on initial roentgenograms in only one case, whereas increased radionuclide uptake was a consistent finding on the bone scan. The diagnosis was established only by magnetic resonance imaging in five cases. All six patients were women and four were older than 75 years. Two patients had a history of osteoporotic fractures, one had laboratory test evidence of osteomalacia and one had recurrent insufficiency fractures mistakenly ascribed for several years to migratory transient osteoporosis. bone density was subnormal in five of the six patients. rest and standard analgesics consistently ensured a favorable outcome within three to four weeks. To our knowledge there have been no previous reports of stress fractures of the medial femoral condyle. These lesions may be underdiagnosed since they are easily mistaken for primary osteonecrosis in the absence of magnetic resonance imaging. Primary osteonecrosis of the femoral condyle shares several features with insufficiency fractures, including predominance in elderly women with factors responsible for mechanical stress (varum, obesity, trivial trauma), mechanical pain, and increased radionuclide uptake. Because some cases of primary osteonecrosis may be secondary to undiagnosed stress-related microfractures, early diagnosis and elimination of weight bearing are essential.- - - - - - - - - - ranking = 3keywords = osteonecrosis (Clic here for more details about this article) |