Subchondral fatigue fracture of the femoral head in military recruits.
BACKGROUND
Subchondral stress fracture of the femoral head is a rare condition that usually occurs as an insufficiency fracture in people with poor bone quality. We evaluated the clinical characteristics of subchondral fatigue fractures of the femoral head that occurred in young, healthy military recruits.


METHODS
Between January 1998 and November 2001, seven subchondral fatigue fractures of the femoral head were treated in five patients. The characteristics of this condition were ascertained by assessing the clinical course as well as radiographs, bone scintigrams, and magnetic resonance images.


RESULTS
All patients were male military recruits in their early twenties in whom pain had developed within five months after recruitment. Definite abnormal findings were observed on the initial radiographs of four hips in three patients, and the femoral head was markedly collapsed in two of these four hips. Bone scintigrams were made of five hips in four patients, and all of them showed increased radionuclide uptake in the femoral head. In all affected hips, magnetic resonance images demonstrated a localized or diffuse bone-marrow-edema pattern in the femoral head and/or neck. A subchondral fracture line (a magnetic resonance crescent sign) was identified in all hips. In the patients who did not have collapse of the femoral head, the pain decreased gradually and disappeared completely within six months, with correspondingly improved findings on sequential magnetic resonance images. The patients with femoral head collapse were treated with total hip arthroplasty or an iliac bone strut graft.


CONCLUSIONS
When a military recruit or an athlete reports hip pain, a diagnosis of subchondral fatigue fracture of the femoral head should be considered.
Song
Won Seok
WS
Department of Orthopaedic Surgery, Seoul National University Hospital, 28 Yongondong Chongnogu, Seoul 110-744, Korea.
Yoo
Jeong Joon
JJ
Koo
Kyung-Hoi
KH
Yoon
Kang Sup
KS
Kim
Young-Min
YM
Kim
Hee Joong
HJ
D000328:Adult; D005270:Femur Head / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D015775:Fractures, Stress / Q000175:diagnosis / Q000628:therapy; D006620:Hip Fractures / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008889:Military Personnel; D014057:Tomography, X-Ray Computed; D014481:United States