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Stressfrakturen des Schenkelhalses bei femoroazetabulärem Impingement

Eine retrospektive Fallstudie und Literaturübersicht

Femoral neck stress fractures and femoroacetabular impingement

A retrospective case study and literature review

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Zusammenfassung

Hintergrund

Femoroazetabuläres Impingement (FAI) kann infolge unnatürlicher Druckmechanismen zu Strukturschäden von Pfanne und Schenkelhals führen. Bislang wenig beachtet ist das vereinzelt beschriebene Phänomen von Stressfrakturen des Schenkelhalses im Zusammenhang mit FAI. Ziel dieser Arbeit ist eine Zusammenstellung eigener Fälle und die Beschreibung der verfügbaren Literatur.

Material und Methoden

Im Dresdner Hüftregister wurden von 2015 bis 2018 fünf Patienten mit nichttraumatischer Schenkelhalsfraktur und gleichzeitigem FAI operativ versorgt. Es erfolgte die retrospektive Auswertung soziodemografischer Merkmale der betroffenen Patienten sowie Komorbiditäten, radiologischer Befunde und endokrinologischer Diagnostik. Zusätzlich wurde eine Literatursuche mit Stressfraktur- und FAI-assoziierten Schlüsselwörtern vorgenommen.

Ergebnis

Das Durchschnittsalter der 5 behandelten Patienten (6 Frakturen) beträgt 39 Jahre (22–52 Jahre), 2 davon sind weiblich und 3 männlich. Es wurden insgesamt 12 operative Eingriffe durchgeführt. In 4 von 5 Fällen besteht ein Pincer-FAI oder/und ein Cam-FAI und bei 3 von 5 Patienten ist die femorale Antetorsion vermindert (−7° bis +7° Antetorsion). Drei Patienten weisen eine zusätzliche Durchblutungsstörung des Hüftkopfes im Sinne einer avaskulären Nekrose ARCO-Stadium 1 auf. In bislang publizierten Kasuistiken sind ähnliche Verläufe beschrieben, ohne FAI-spezifische Therapiemaßnahmen zu adressieren.

Diskussion

Die Auswertung unserer Fälle sowie die Analyse ähnlicher Verläufe in der bislang publizierten Literatur legt nahe, dass Impingement-assoziierte Deformitäten zu den Risikofaktoren für die Entstehung von Stressfrakturen des Schenkelhalses zählen und bei der diagnostischen Abklärung bzw. Therapieplanung zu berücksichtigen sind.

Abstract

Background

Femoroacetabular impingement (FAI) can lead to morphologic damage of both the acetabulum and the femoral neck. Recent reports have found an association between impingement deformities and the development of femoral neck stress fractures. The aim of this study was to report a series of patients with these findings and to update the current evidence on the topic.

Material and methods

5 patients (6 cases) with atraumatic femoral neck fractures and FAI were identified in the Dresden hip registry from 2015 to 2018. Demographic data, comorbidities, radiographic results and bone metabolism results were described. A literature search was conducted using keywords related to femoral neck stress fractures and FAI syndrome.

Results

The average age of the series was 39 (range: 22–52), 2 patients were female and 3 male. A total of 12 surgical procedures were performed. 4 of the 5 patients showed radiographic features of pincer and/or cam-FAI, whereas 3 patients had a decreased femoral antetorsion (−7° to +7° antetorsion). In 3 patients, magnetic resonance imaging revealed additional signs of avascular necrosis ARCO I. There was a lack of FAI-specific treatment recommendations in the available literature.

Discussion

Radiographic results of the patients evaluated suggested that impingement-associated deformities of the hip may cause femoral neck stress fractures, which is in line with the available literature. This potential coincidence should be integrated in diagnostic algorithms and therapeutic approaches.

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Abbreviations

ACTH:

Adrenokortikotropes Hormon

ARCO :

Association Research Circulation Osseous

AVN :

Avaskuläre Hüftkopfnekrose

CCD-Winkel :

Centrum-Collum-Diaphysen‐Winkel

CE-Winkel :

Centrum-Erker-Winkel

CRP :

C‑reaktives Protein

DHS :

Dynamische Hüftschraube

FAI :

Femoroazetabuläres Impingement

FS :

Fettsuppression

FSH :

Folikelstimulierendes Hormon

FT3 :

Freies Trijodthyronin

FT4 :

Freies Thyroxin

GFR :

Glomeruläre Filtrationsrate

GT :

Glutamyltransferase

HASA :

Hinterer azetabulärer Sektorenwinkel

IGF1 :

„Insulin-like growth factor 1“

LH :

Luteinisierendes Hormon

PAO :

Periazetabuläre Osteotomie

PD :

Proton Density

RCT :

„Randomized controlled trial“

SD :

Standardabweichung

SHF :

Schenkelhalsfraktur

TEP :

Totalendoprothese

TSE :

Turbo Spin Echo

TSH :

Thyreoidea-stimulierendes Hormon

VASA :

Vorderer azetabulärer Sektorenwinkel

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Authors and Affiliations

  1. UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland

    Lea Franken,  Jens Goronzy, Jörg Nowotny, Albrecht Hartmann, Falk Thielemann & Klaus-Peter Günther

  2. Department for Orthopaedic Surgery and Traumatology, University of Medical Sciences Teaching Hospital Akure/Ondo, Akure/Ondo, Nigeria

    O. O. Olusile

  3. Institute of Orthopaedics ‚Carlos E. Ottolenghi‘, Italian Hospital of Buenos Aires, Buenos Aires, Argentinien

    Pablo Ariel Slullitel

  4. Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland

    Sophia Blum

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  1. Lea Franken
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  2. Jens Goronzy
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Correspondence to Jens Goronzy.

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L. Franken, J. Goronzy, O.O. Olusile, P.A. Slullitel, S. Blum, J. Nowotny, A. Hartmann, F. Thielemann und K.-P. Günther geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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L. Franken und J. Goronzy teilen sich die Erstautorenschaft.

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Franken, L., Goronzy, J., Olusile, O.O. et al. Stressfrakturen des Schenkelhalses bei femoroazetabulärem Impingement. Orthopäde 50, 224–236 (2021). https://doi.org/10.1007/s00132-020-03916-6

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