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Seo, Nam, Yoo, Kim, and Kim: Pathologic Fracture in a Subchondral Cystic Lesion at the Superior Acetabulum
Case Report
Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(2): 160-163.

Published online: 19 April 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.2.160

Pathologic Fracture in a Subchondral Cystic Lesion at the Superior Acetabulum

Kyu Bum Seo, M.D.*, Kwang Woo Nam, M.D.*, Jeong Joon Yoo, M.D., Hee Joong Kim, M.D., Sang Rim Kim, M.D.*

Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

*Department of Orthopedic Surgery, College of Medicine, Jeju National University, Jeju, Korea.

Correspondence to: Kwang Woo Nam, M.D. Department of Orthopedic Surgery, Jeju National University Hospital, 1753-3, Ara 1-dong, Jeju 690-716, Korea. TEL: +82-64-717-1690, FAX: +82-64-717-1131, kanguking@yahoo.co.kr

Received 10 June 2009       Accepted 22 December 2009

Copyright © 2010 by The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Subchondral cyst is a benign cystic lesion, and it is often found in patients with rheumatoid arthritis or osteoarthritis. However, its occurrence in those joints without preexisted disease is rare. Furthermore, there has been no report in the medical literature regarding pathologic fracture in the bony plate of a subchondral cyst at the superior acetabulum. We report here on a case of the 44-year-old woman for whom a pathologic fracture was found in the bony plate of a subchondral cyst at the superior acetabulum.

Keywords: acetabulum, subchondral cyst, bony plate fracture, pathologic fracture

Figures and Tables

Figure 1
Both hip anteroposterior and frog leg radiographs obtained two months after the onset of pain in the right hip show ill-defined osteolytic lesion with focal poorly delineated right acetabular cortex.
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Figure 2
Coronal T1 and T2-weighted magnetic resonance images obtained at about two weeks later show that subchondral bone plate of right superior acetabulum is destructed and heterogeneous low signal intensity on T1-weighted image, which converted to heterogeneous high signal intensity at T2-weighted image. There are diffuse bone marrow signal change and enhancement at superior acetabulum and ilium.
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Figure 3
Axial T2-weighted enhanced magnetic resonance image obtained at about two weeks later shows diffuse bone marrow signal change at ilium and ill-defined round enhancement of the anterolateral aspect at right superior acetabulum.
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Figure 4
Pelvis anteroposterior and oblique radiographs obtained twenty seven months after the onset of pain in the right hip show residual cortical irregularity of right acetabulum.
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Figure 5
Coronal T2-weighted fat suppression magnetic resonance image obtained twenty seven months after onset of pain in the right hip does not show reactive change such as bone marrow edema and synovial enhancement. Also T2-weighted magnetic resonance image shows that destructed bony plate of superior acetabulum is migrated.
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Figure 6
Axial computed tomographic image obtained twenty seven months after onset of pain in the right hip shows a subchondral cyst with subchondral bone plate fracture at right superior acetabulum and shows medullary sclerosis around subchondral cystic lesion.
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References

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