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Osteologie 2016; 25(03): 143-149
DOI: 10.1055/s-0037-1619011
Muskuloskelettale Radiologie
Schattauer GmbH

Differenzierung subchondraler Insuffizienzfrakturen von Osteonekrosen

Differentiation of subchondral insufficiency fractures from osteonecrosis
A. L. Falkowski
1   Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Basel, Schweiz
,
A. Hirschmann
1   Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Basel, Schweiz
› Author Affiliations
Further Information

Publication History

eingereicht: 10 February 2016

angenommen: 28 March 2016

Publication Date:
21 December 2017 (online)

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Zusammenfassung

Osteonekrosen und subchondrale Insuffizienzfrakturen beruhen auf unterschiedlichen Pathomechanismen. So ist bei der Osteonekrose die Blutversorgung des Knochens gestört, sodass auch ein multifokaler Befall auftreten kann. Bei der subchondralen Insuffizienzfraktur ist die Blutversorgung intakt, der Knochen jedoch in seiner Architektur gestört, sodass dieser normalen Belastungen nicht mehr standhalten kann. Neben der Anamnese des Patienten ist radiologisch die charakteristische Form der Demarkierungsrespektive Frakturlinie zur Gelenkfläche ein entscheidendes Diagnosekriterium. Ein Knochenmarködem liegt in beiden Entitäten vor und gilt bei der Osteonekrose als Risikofaktor eines Gelenkflächeneinbruchs. Die Quantifizierung der Knochenveränderung hilft dem zuweisenden Kollegen in der Entscheidung der Therapiewahl, da diese die Prognose beeinflusst. Eine frühzeitige Diagnostik mittels MRT ist notwendig, da konventionell radiologische Frühzeichen fehlen. Hierdurch kann eine adäquate Therapie zeitgerecht eingeleitet werden, um einen Gelenkflächeneinbruch mit sekundärer Arthrose zu verhindern.

Summary

Osteonecrosis and subchondral insufficiency fractures rely on different pathomechanisms. Osteonecrosis is based on an insufficient blood supply of the bone, and thus may occur multifocal. The blood supply in subchondral insufficiency fractures is intact, however, the bony architecture is disturbed. Therefore, even normal load weakens the bone and may lead to a fracture. Beside clinical history, the shape of the demarcationor fracture-line in relation to the joint surface on radiological images is characteristic. Bone marrow edema is evident in both entities and can be considered as a risk factor for collapse of the articular surface in osteonecrosis. Additionally, the extent of osteonecrosis or insufficiency fractures should be reported, as it affects prognosis and therapy. Initial radiographs may be unremarkable. Therefore, MRI is crucial for early stage diagnosis and timely treatment in order to prevent from articular surface collapse and secondary osteoarthritis.

Schlüsselwörter

Osteonekrose - subchondrale Insuffizienzfraktur - Hüfte - Knie

Keywords

Osteonecrosis - subchondral insufficiency fracture - hip - knee
 

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