Rapid Destructive Arthrosis Due to Subchondral Insufficiency Fracture of the Shoulder: Clinical Characteristics, Radiographic Appearances, and Outcomes of Treatment

The purpose of our study was the clinical characteristics, radiographic appearance, and outcomes after treatment in patients with rapid destructive arthrosis (RDA) due to subchondral insufficiency fracture (SIF) of the shoulder. Twenty-two cases of RDA of the shoulder were retrospectively reviewed. Clinical outcomes for 15 cases who underwent shoulder arthroplasty were evaluated at an average of 41.4 months. The mean age of patients was 73.7 years (range 50–83 years), and there were 20 women and 2 men. The mean time from onset of symptoms to head collapse was 6.8 months (range 1–12 months). The mean t-score of bone mineral density was −3.1. Nine patients had pseudoparalysis. Based on radiographic appearance, a diversity of types of head destruction with subchondral fracture, bone marrow edema, joint effusion, and synovitis were observed in all cases. In conclusion, RDA due to SIF of the shoulder, presenting with severe short-term pain and functional disability, commonly occurred in elderly women with bone fragility. MRI revealed bone marrow edema, extensive joint effusion, and synovitis as well as a diversity of types of head destruction with subchondral fracture within several months from onset of symptoms.

Subchondral fracture of the femoral head in children: Differential diagnosis of pediatric hip pain

This report describes clinical and radiographic characteristics of two pediatric patients with a presumptive diagnosis of subchondral fracture of the femoral head made based on their clinical course and imaging findings. An 8-year-old boy and an 8-year-old girl had subchondral fracture in the femoral head without osteonecrosis, which was verified by contrast-enhanced magnetic resonance imaging. Although complete disappearance of the fracture line was confirmed in the boy, the girl had a residual femoral head deformity after conservative treatment. Subchondral fracture of the femoral head should be included in the differential diagnosis of pediatric hip pain.