Transtrochanteric Rotational Osteotomy for a Subchondral Insufficiency Fracture of the Femoral Head in Young Adults

Abstract

While subchondral insufficiency fracture of the femoral head is most frequently seen in elderly patients, this fracture has also been reported in some young individuals. We asked whether a transtrochanteric rotational osteotomy for a subchondral insufficiency fracture of the femoral head in young adults would (1) provide improvement in functional scores; and (2) lead to healing of the fractures. We retrospectively reviewed five young patients diagnosed with subchondral insufficiency fracture of the femoral head. Nonoperative treatment was administered initially. Four of these patients (average 22.3, years; range, 16-29 years) showed progressive collapse. An anterior rotational osteotomy was performed in these four patients since the fractured area was located in the anterosuperior portion of the femoral head. All patients were followed for a minimum of 2.0 years (average, 4.1 years; range, 2.0-9.1 years). The average preoperative Harris hip score was 71.6 points, which improved to an average of 97.2 at the latest followup. Radiographically, the fractured lesion healed and no progression of collapse was observed in any of the four patients. Anterior rotational osteotomy seems a useful surgical option for treating young patients with subchondral insufficiency fracture of the femoral head if symptoms persist.