What Is a Subchondral Fracture?

$subchondral-fracture$

Subchondral Fracture

Repetitive stress causes a subchondral fracture, a form of injury that affects the layer of bone tissue just below the cartilage. Elderly people's knees or hips are frequently affected.

Non-traumatic subchondral fractures are those that aren't brought on by a fall, a blow, or any other traumatic event. Instead, they develop as a result of constant loading throughout time.

Additionally, they are known as subchondral insufficiency fractures. A specific kind of stress damage known as "insufficiency" usually affects weight-bearing joints including the knees and hips.

Although it is not the primary cause, low bone density can increase your risk of suffering one of these fractures.

Here are some details on their types, causes, and treatments.

Types of subchondral fractures

Subchondral fractures mainly fall into one of two categories. The first happens in the knee, whereas the second happens in the hip. However, other sections of your body may also exhibit symptoms.

Knee subchondral fracture

The tissue under the cartilage in the knee is repeatedly stressed, which results in subchondral insufficiency fractures (SIFK). These are typical reasons why middle-aged and older persons experience joint pain.

Hip subchondral fracture

A lack of subchondral tissue Repetitive stress on the hip joints leads to fracture of the femoral head. The femoral head is a ball that connects the thighbone's upper end to the pelvic bone.

These typically affect older persons and are similar to subchondral knee fractures.

What are the symptoms of a subchondral fracture?

Subchondral fractures are frequently first identified by the intense pain felt near the bone. There won't frequently be a readily apparent cause. But you'll probably be able to recall when the discomfort started.

These fractures can happen in the ankles, wrists, shoulders, elbows, or other joints, however, most frequently happen in the hips or knees. Due to fluid accumulation in the joint, your joints will feel swollen.

When lifting things, the pain typically gets worse. Even when sleeping, particularly at night, it will continue. Over time, the discomfort will also probably get worse, especially if nothing is done about it.

You might only have discomfort in one hip or knee because the pain is typically one-sided. The feeling was present in both, though.

What causes a subchondral fracture?

Repetitive stress is the main cause of subchondral fractures, which typically have no visible explanation. Over time, walking, running, or performing routine duties may be enough to create micro-fractures in the bone.

Although osteoporosis or low bone density may increase the risk of subchondral fracture, they are not the actual cause.

Subchondral fracture risk factors

Women over the age of 50 are more likely than men to get subchondral injuries to the knees and hips.

Another risk factor for bone damage, including fractures, is women's propensity for osteoporosis and bone density decrease over time.

Running or other repetitive motion sports may increase the risk of subchondral fractures in some people.

How is a subchondral fracture diagnosed?

MRI can be used to identify subchondral fractures in the very early stages. But your doctor may start by requesting an X-ray.

The doctor will request an MRI if the results of the X-ray are unclear and you are still having ongoing pain. An easy way to find a subchondral fracture is with an MRI.

The clinician should be able to observe small bands in the tissue that are uneven and unconnected, although subchondral fractures can be difficult to detect with other forms of diagnostic imaging.

In some cases, bone collapse and bone marrow oedema (when fluid accumulates in the soft tissue) may also be seen.

It is not advised to take radiographs of subchondral fractures because they normally don't show any abnormalities. This is why a doctor could advise getting an MRI if an older person with the illness suddenly develops joint discomfort.

Treatment for a subchondral fracture

Doctors typically advise noninvasive management as the initial course of treatment. Protected weight-bearing is typically the first phase, which means that you should only bear weight temporarily while using walking aids (like crutches). Additional measures could be used, such as:

physical therapy
bisphosphonates (a type of osteoporosis medication)
teriparatide (another osteoporosis drug)
steroid injections
insole therapy
nonsteroidal anti-inflammatory drugs

Experts are investigating techniques including decompressing the hip and restoring the joint with bone filler. However, before putting such strategies into practice on a larger scale, thorough research is required. Cooled radiofrequency ablation for pain management combined with bone infusions to address the weakening bone is another method that may be considered.

The disorder can be treated with physical therapy, vitamin D supplementation, and several other experimental techniques.

If the problem continues for more than 3 to 8 months, a more serious intervention may be required.

For instance, total hip arthroplasty may be the next step needed in the event of a serious femoral head fracture. In this procedure, an implant is used to replace the natural joint between the femur and pelvis. An advanced SIFK case may require a knee replacement.

There is no universally accepted treatment for progressive subchondral fractures since they can be notoriously difficult to maintain. In the end, deciding on the best course of therapy will be up to you and your doctor.

How much time does it take for a subchondral fracture to heal?

The time it takes for a subchondral fracture to heal varies depending on the type of treatment used.

According to a small 2007 study, persons with the illness recovered after receiving conservative management (which included measures including protected weight-bearing, insole therapy, anti-inflammatory medications, and bisphosphonates) in an average of 4.8 months. The research participants' MRIs went back to baseline after roughly 8 months.

Healing could take substantially longer following surgical intervention, such as total joint replacement. The issue may be more difficult to treat and heal the larger the lesion size. Because of this, some people may have trouble getting the lesion to heal. Total joint replacement is typically thought of as a last resort.

Osteonecrosis and osteochondral collapse, which result in the death of the joint, can develop if the bone tissue does not mend on its own or with medical assistance.

It occurs when the blood supply to the knee is interrupted. Since bone cells require a consistent blood supply to live, osteonecrosis can result in severe arthritis and complete joint loss.

More powerful techniques to treat these fractures are still being developed by experts. The need for early identification and care is due to potential consequences.

Takeaway

About subchondral fractures, the tissue beneath the cartilage of a joint breaks down. They frequently happen in older persons as a result of repetitive motion over time.

Noninvasive techniques including shielded weight-bearing and anti-inflammatory medications can help treat the problem in mild cases. Surgery (including hip or knee replacement) can be required in more extreme situations.

Consult your doctor if a joint, such as your hip, knee, or shoulder, has suddenly become painful. The outlook is brighter if the problem is identified and treated earlier.