📌 The Gravid Hip: Subchondral Insufficiency Fracture of the Femoral Head (Pregnancy & Puerperium)

https://youtu.be/jz3XQMZ3SKA

https://youtube.com/shorts/mwgqySnkXEE

What it is 

• In late pregnancy / early postpartum, severe hip pain with diffuse femoral head BME is often labeled “TOH,” but small-FOV MRI frequently reveals an occult subchondral fracture line.
• Practical takeaway: TOH and SIF are a spectrum, and the fracture (SIF) is the structural event that drives the edema.

 

MRI: must-mention findings (non-contrast)

• Bone marrow edema pattern (BMES)
• Subchondral fracture line = key diagnostic sign
• Articular surface integrity
• Joint effusion (often mild–moderate).
• No contrast needed in most cases; gadolinium generally avoided in pregnancy unless exceptional indication.

 

Radiograph (X-ray): what to expect

• Frequently normal early.
• Later: osteopenia of femoral head may appear weeks after symptom onset, so X-ray cannot exclude SIF/TOH in the acute phase.

 

Imaging differentials you must separate (Hip MRI)

• AVN: focal/geographic necrotic segment, double-line sign, typical band configuration; less “diffuse-only” edema pattern.
• Transient osteoporosis of pregnancy (TOH): diffuse edema without a definite fracture line (but many “TOH” cases hide SIF on high-resolution MRI).
• Septic arthritis: prominent synovitis, erosions, aggressive marrow change, systemic clinical correlation.

 

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