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CASE OF THE quarter


A previously-healthy, normal-weight 70-year-old female without osteoporosis, presents with the following:

  • 3/2019 Sudden pain with weight-bearing in the right hip/groin, stiffness, radiculopathy.  Conservative physical therapy initiated.
  • 7/2019: Continued pain, requires a cane to ambulate. Radiograph mild degenerative joint disease/osteoarthritis. Cortisone injection into SI joint provides relief; no injections given to right hip joint.
  • 10/2019: Pain continues. Retrospective review of this late MRI reveals the final diagnosis that caused the degenerative joint disease/osteoarthritis (DJD/OA), now moderate to severe. A total right hip arthroplasty is performed, ten months later, 5/2020, due to COVID-19. 

The surgeon thought and submitted this case to pathology as common DJD/OA.

Click on the below thumbnails to enlarge photos.

<< All album photos 6/11 photos


1. What is your diagnosis?

A. Primary osteonecrosis.

B. Primary osteoarthritis.

C. Subchondral enchondroma.   

D. Subchondral insufficiency fracture.

E. Primary osteomalacia.

2. What are the known risk factors for subchondral insufficiency fracture (SIF)?

A. Steroids or alcohol abuse

B. Trauma – high external force

C. Bisphosphonate fracture

D. Obesity, osteoporosis, elder female

E. Osteomyelitis

3. Which one of the following is correct?

A. Subchondral insufficiency fracture cannot be treated by rest.

B. Subchondral insufficiency fracture is typically bilateral and due to steroids.

C. Subchondral insufficiency fracture occurs due to abnormal activity (strong force) on normal bone.

D. Subchondral insufficiency fracture occurs in obese with weight bearing, may  be elderly female with osteoporosis.

E. Subchondral insufficiency fracture occurs with high energy force trauma to osteoporotic bone.

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Dr. Julie C. Fanburg-Smith

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