The Department of Orthopaedic Surgery at UCSF provides expert treatment for all aspects of musculoskeletal injuries including inpatient and outpatient surgical care, rehabilitation, and orthotics and prosthetics. Our physicians have specific training and experience in a broad range of orthopaedic specialties such as sports medicine, trauma, joint replacement, pediatrics, oncology, spine, shoulder and elbow, foot and ankle, and hand. The Department is internationally recognized for its work in patient care, education, and research. Our basic and translational research programs focus on cartilage and disc regeneration, fracture healing, molecular and stem cell biology, bioengineering, and musculoskeletal development.
Subchondral insufficiency fractures of the femoral head: associated imaging findings and predictors of clinical progression.
OBJECTIVES:To characterize the morphology and imaging findings of femoral head subchondral insufficiency fractures (SIF), and to investigate clinical outcomes in relation to imaging findings. METHODS:Fifty-one patients with hip/pelvis magnetic resonance (MR) images and typical SIF characteristics were identified and reviewed by two radiologists. Thirty-five patients had follow-up documentation allowing assessment of clinical outcome. Subgroup comparisons were performed using regression models adjusted for age and body mass index. RESULTS:SIF were frequently associated with cartilage loss (35/47, 74.5 %), effusion (33/42, 78.6 %), synovitis (29/44, 66 %), and bone marrow oedema pattern (BMEP) (average cross-sectional area 885.7 ± 730.2 mm(2)). Total hip arthroplasty (THA) was required in 16/35 patients, at an average of 6 months post-MRI. Compared to the THA cohort, the non-THA group had significantly (p < 0.05) smaller overlying cartilage defect size (10 mm vs. 29 mm), smaller band length ratio and fracture diameters, and greater incidence of parallel fracture morphology (p < 0.05). Male gender and increased age were significantly associated with progression, p < 0.05. CONCLUSIONS:SIF were associated with synovitis, cartilage loss, effusion, and BMEP. Male gender and increased age had a significant association with progression to THA, as did band length ratio, fracture diameter, cartilage defect size, and fracture deformity/morphology. KEY POINTS:• Femoral head subchondral insufficiency fractures (SIF) frequently require total hip arthroplasty (THA). • SIF frequently coexist with synovitis, cartilage loss, and bone marrow oedema pattern. • SIF cartilage defect size, band length ratio, and fracture diameter/morphology can predict progression risk.