Elderly female with left hip pain. The patient has no recent history of trauma. Insufficiency fracture of the femoral neck.
Insufficiency fractures are a result of normal physiologic stresses on abnormal bones.
This most often occurs in elderly individuals with osteoporosis, but others, such as those with rheumatoid arthritis or renal osteodystrophy may be affected. In addition, patients on chronic steroid therapy or following irradiation, may also develop insufficiency fractures. When associated with senile osteoporosis, the insufficiency fractures most commonly involve the subcapital region of the femoral neck, but other regions may also fracture. The plain film findings are often subtle and include vague sclerosis as well as periostitis or buttressing. MRI is highly sensitive for the detection of femoral neck insufficiency fractures, and may be quite helpful when the plain film is nondiagnostic.