The Metatarsal Cortical Index as an Indicator of Insufficiency Fracture of the Foot

Abstract Background Fragility fractures of the pelvis (FFP) encompass two fracture entities: fracture after low-energy trauma and insufficiency fracture without trauma. It is unclear whether the two subgroups differ in terms of diagnosis and therapy. The aim of this retrospective study was to evaluate insufficiency fractures with regard to defined parameters and to compare specific parameters with the fractures after low-energy trauma. Patients and Methods In the period from 2008 to 2017, 203 patients with FFP were recorded at our clinic (Level 1 Trauma Centre DGU, SAV approval). Of these, 25 had an insufficiency fracture and 178 had a pelvic ring fracture after low-energy trauma. Epidemiological, diagnostic and therapeutic parameters were examined. Results There was a relative increase in the insufficiency fracture within the FFP (2008 – 2009: 5.0% vs. 2015 – 2017: 17.8%). In these patients, osteoporosis tended to be more pronounced than in patients after low-energy trauma (t-value: − 3.66 vs. − 3.13). The diagnosis of insufficiency fractures showed increased use of MRI and DECT (60.9% vs. 26.0%) and a high proportion of type IV fractures after FFP (40.0% vs. 7.9%). In terms of therapy, surgical treatment of the insufficiency fracture was sought more often (68,2% vs. 52,1%), with a tendency towards increased use of combined osteosynthesis procedures (14.3% vs. 7.6%). Conclusion We were able to show that as the number of cases increases, the insufficiency fracture becomes more important within FFP. If these patients tend to have more pronounced osteoporosis, particular attention should be paid to the diagnosis and adequate therapy of the osteoporosis, especially in the case of an insufficiency fracture. In addition to the increased diagnostic testing using MRI and DECT to detect oedema and the increased surgical therapy for this type of fracture, it is also noteworthy that the insufficiency fracture can cause higher-grade fractures after FFP.

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Acute Neurological Deficit Due to Sacral Insufficiency Fracture With Coexistent Severe Lumbar Canal Stenosis: A Case Report

HSS Journal ® ◽

10.1177/15563316211006665 ◽

2021 ◽

pp. 155633162110066

Author(s):

Bhavuk Garg ◽

Nishank Mehta

Keyword(s):

Case Report ◽

Neurological Deficit ◽

Insufficiency Fracture ◽

Sacral Insufficiency Fracture ◽

Lumbar Canal Stenosis ◽

Canal Stenosis

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Pelvic insufficiency fracture with diastasis of the pubic symphysis after irradiation

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.80b2.0800264 ◽

1998 ◽

Vol 80-B (2) ◽

pp. 264-266 ◽

Cited By ~ 1

Author(s):

C. Rex ◽

C. Elsworth

Keyword(s):

Insufficiency Fracture ◽

Pubic Symphysis ◽

Pelvic Insufficiency Fracture

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Insufficiency fracture of the calcaneum: an unusual cause of heel pain

The Foot ◽

10.1054/foot.2000.0601 ◽

2000 ◽

Vol 10 (3) ◽

pp. 169-171 ◽

Cited By ~ 1

Author(s):

K.C. Pande ◽

R.U. Ashford ◽

A. Dey ◽

K. Kayan ◽

E.V. McCloskey ◽

...

Keyword(s):

Insufficiency Fracture ◽

Heel Pain

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The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

The American Journal of Sports Medicine ◽

10.1177/03635465211002160 ◽

2021 ◽

pp. 036354652110021

Author(s):

Han Gyeol Choi ◽

Joo Sung Kim ◽

Hyun Jin Yoo ◽

You Sun Jung ◽

Yong Seuk Lee

Keyword(s):

Bone Marrow ◽

High Tibial Osteotomy ◽

Insufficiency Fracture ◽

Tibial Osteotomy ◽

Pathological Feature ◽

Open Wedge ◽

Varus Malalignment ◽

Bone Marrow Lesions ◽

Wedge High Tibial Osteotomy

Background: Subchondral insufficiency fracture of the knee (SIFK) is characterized by a subchondral lesion that may lead to end-stage osteoarthritis (OA). In patients who have SIFK in a precollapse state with varus malalignment, a joint-preserving technique such as open wedge high tibial osteotomy (OWHTO) should be considered. Purpose: To evaluate the efficacy of OWHTO in primary OA and SIFK-dominant OA by clinical and radiological evaluations including magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence 3. Methods: A total of 33 SIFK-dominant OA knees and 66 with primary OA that underwent biplanar OWHTO between March 2014 and February 2016 were included after 1:2 propensity score matching. The MRI Osteoarthritis Knee Score was used to assess bone marrow lesions (BMLs) preoperatively and at follow-up. The weightbearing line ratio, the hip-knee-ankle angle, and the joint line convergence angle were measured. The clinical outcomes assessed were range of motion, the American Knee Society Score, and the Western Ontario and McMaster University (WOMAC) score. Results: The mean follow-up period was 41.2 ± 12.6 months. The distribution of preoperative BML grade in the SIFK-dominant OA group was significantly higher in both the femur and tibia ( P < .001 and <.001, respectively) than that in the primary OA group. However, the difference was not significant postoperatively (femur, P = .425; tibia, P = .462). In both groups, postoperative BMLs showed significant improvement compared with preoperative BMLs (primary OA [femur, P < .001; tibia, P = .001] and SIFK-dominant OA [femur, P < .001; tibia, P < .001]). The WOMAC pain score was higher in the SIFK-dominant OA group preoperatively (primary OA, 7.0 ± 3.73; SIFK-dominant OA, 9.17 ± 2.6; P = .032) even though it was not different at the final follow-up (primary OA, 2.11 ± 1.7; SIFK-dominant OA, 1.79 ± 1.32; P = .179). Conclusion: OWHTO is an effective procedure not only for primary OA but also for SIFK-dominant OA. OWHTO can improve BMLs, which represent the main pathological feature of SIFK. Therefore, in patients who have SIFK with varus malalignment, OWHTO can be an attractive treatment option for preserving the joint and enhancing subchondral bone healing.

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