European Radiology

, Volume 14, Issue 2, pp 201–207 | Cite as

Subchondral insufficiency fractures of the femoral head

  • M. Davies
  • V. N. Cassar-PullicinoEmail author
  • A. J. Darby


The aim of this study was to increase awareness of, and to show the variable clinical and radiological features of, subchondral insufficiency fractures of the femoral head. The clinical and radiological findings in 7 patients with subchondral insufficiency fractures of the femoral head were reviewed retrospectively. The diagnosis was confirmed histologically in 4 patients. Radiographs were performed in all patients, MRI in 5 and scintigraphy in 4 patients. Radiographs showed varying degrees of femoral head collapse in 4 patients. In the remaining 3 patients radiographs showed a normal femoral head, regional osteoporosis and focal sclerosis, respectively. Magnetic resonance imaging showed a low-signal band on T1- and T2-weighted images in the subchondral bone adjacent or parallel to the articular surface associated with bone marrow oedema. Scintigraphy showed increased uptake in the femoral head. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. Unsuspected insufficiency fracture of the femoral head can lead to significant and rapid loss of bone stock in osteoporotic patients waiting for arthroplasty for osteoarthritis. Increased awareness of this condition will hopefully lead to earlier diagnosis and a successful outcome of conservative treatment.


Femoral head Insufficiency fracture Avascular necrosis Osteoporosis MRI 



The authors gratefully acknowledge P. Cool, P. Gregson, C. McGeogh, R. Spencer-Jones, N. Steele and M.W.J. Davie for clinical details of the patients reported in this study.


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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • M. Davies
    • 1
  • V. N. Cassar-Pullicino
    • 1
    Email author
  • A. J. Darby
    • 2
  1. 1.Department of RadiologyThe Robert Jones and Agnes Hunt Orthopaedic and District HospitalShropshireUK
  2. 2.Department of PathologyThe Robert Jones and Agnes Hunt Orthopaedic and District HospitalShropshireUK

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