(Fig 5-B.36) Subchondral Insufficiency Fracture vs. Osteonecrosis

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📌 Subchondral Insufficiency Fracture (SIF) vs. Osteonecrosis

✅ SIF on MRI

• Low-signal-intensity discontinuous and irregular fracture line
• Parallel to the articular surface of the femoral head

✅  Osteonecrosis on MRI

• Wider, geographic lesions
• Serpentine contour

 

✅ Dynamic Contrast-Enhanced MRI

• Osteonecrosis: Lower maximum enhancement values, longer time to peak, lower slopes
• SIF: Enhancing subchondral portion proximal to the fracture plane (indicating perfused, living bone)
• Osteonecrosis: Non-enhancing regions of dead bone

✅ Importance of Differentiation

• Critical before femoral head collapse
• Osteonecrosis: Considered irreversible
• SIF: May resolve with conservative management

 

✅ Challenging Cases

• Differentiating SIF without underlying osteonecrosis from SIF with underlying osteonecrosis
• Contrast-enhanced studies may be helpful

References: AJR 2019; 213:963–982

 

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