Severe osteoporosis: diagnosis of femoral fractures

Abstract

In the diagnosis of femoral fractures, Radiodiagnostic has a role in the different phases of the natural history of these lesions:- in diagnosis and characterization of fractures,- in follow up of the efficacy of therapy, evolution of fractures and any complications,- in studies of risk factors of fractures.Diagnostic imaging employs method of investigation as Conventional Radiology, still crucial in detection, characterization and control of fracture, Computed Tomography (CT) and Magnetic Resonance (MR), essential in doubt of occult fracture and in differential diagnosis between the possible causes of pathologic fracture. Finally, Dual X-ray Absorptiometry (DXA is still the fundamental methodic in diagnosis and assessment of osteoporosis, while QCT, pQCT and HR-CT are experimental techniques used to study in vivo bone microarchitecture and its metabolic and pathological changes.

Figure 1

- Osteoporotic proximal femur fractures: a) proximal femoral neck fracture b) middle femoral neck fracture c) basilar femoral neck fractures d) inter and subtrochanteric fracture.

Figure 2

- CT scan imaging a) not displaced femoral neck fracture b) non displaced subtrochanteric spiroid fracture.

Figure 3

- MR imaging a) edema of not displaced femoral neck fracture in a fat-suppressed sequence b) borders of the same not displaced femoral neck fracture in a T1-weighted sequence.

Figure 4

CT reconstruction of pathologic fracture of femoral neck.

Figure 5

- MR imaging (IR fat-suppressed sequence) of pathologic basilar femoral neck fractures.

Figure 6

- Post-fracture contrast enhancement evaluation of femural heads.

Figure 7

- X-ray examples of osteosynthesis a) arthroprothesis b) cannulated screws c) intramedullary nailing.

Figure 8

- Complications of surgical treatment: a) through-cut of plates, b) fracture in limb with prothesis, c) arthroprothesis dislocation, d) non union, e) CT control of a delayed union, f) MRI evidence of osteomyelitis and pseudoarthrosis.

Figure 9

- Singh index.

Figure 10

- Progressive trabecular bone rarefaction.

Figure 11

- DXA: a) lumbar spine scan; b) proximal femur scan; c) BMD results.

Figure 12

- a) Lumbar QCT b) radial pQCT evaluation; c) mechanical properties evaluation by vQCT; d) HR-pQCT of distal radius.