Yang JZ, Chen P, Chen BH, Zhao B. Subchondral fatigue fracture of the femoral head in young military recruits: Potential risk factors. World J Clin Cases 2023; 11(28): 6733-6743 [PMID: 37901035 DOI: 10.12998/wjcc.v11.i28.6733]
Corresponding Author of This Article
Bin Zhao, MD, PhD, Surgeon, Department of Sports Medicine, the Fourth Medical Center, Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing 100048, China. zhao7202bin@163.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 6, 2023; 11(28): 6733-6743 Published online Oct 6, 2023. doi: 10.12998/wjcc.v11.i28.6733
Subchondral fatigue fracture of the femoral head in young military recruits: Potential risk factors
Jun-Zheng Yang, Peng Chen, Bai-Hao Chen, Bin Zhao
Jun-Zheng Yang, The Fifth Clinical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
Peng Chen, Department of Orthopaedics, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
Bai-Hao Chen, First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
Bin Zhao, Department of Sports Medicine, the Fourth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
Author contributions: Yang JZ and Chen P prepared the manuscript; Chen P and Zhao B collected the clinical data; Yang JZ and Chen BH analyzed the clinical data and prepared the tables and figures; Zhao B revised the manuscript.
Institutional review board statement: This study was approved by the Ethics Review Board of PLA General Hospital, which waived the need to obtain written informed consent (No. 2019-019-01).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Zhao, MD, PhD, Surgeon, Department of Sports Medicine, the Fourth Medical Center, Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing 100048, China. zhao7202bin@163.com
Received: July 25, 2023 Peer-review started: July 25, 2023 First decision: August 16, 2023 Revised: August 20, 2023 Accepted: September 11, 2023 Article in press: September 11, 2023 Published online: October 6, 2023
Abstract
BACKGROUND
Subchondral fatigue fracture of the femoral head (SFFFH) mainly occurs in young military recruits and might be confused with osteonecrosis of the femoral head. However, less research focuses on the risk factor for SFFFH.
AIM
To evaluate the intrinsic risk factors for SFFFH in young military recruits.
METHODS
X-ray and magnetic resonance imaging data were used for analysis. Acetabular anteversion of the superior acetabulum, acetabular anteversion of the center of the acetabulum (AVcen), anterior acetabular sector angle (AASA), posterior acetabular sector angle, superior acetabular sector angle, neck-shaft angle (NSA), inferior iliac angle (IIA), and ischiopubic angle were calculated. Then, logistic regression, receiver operating characteristic curve analysis, and independent samples t-test were performed to identify the risk factors for SFFFH.
RESULTS
Based on the results of logistic regression, age [odds ratio (OR): 1.33; 95% confidence interval (95%CI): 1.12-1.65; P = 0.0031] and treatment timing (OR: 0.86; 95%CI: 0.75-0.96; P = 0.015) could be considered as the indicators for SFFFH. AVcen (P = 0.0334), AASA (P = 0.0002), NSA (P = 0.0007), and IIA (P = 0.0316) were considered to have statistical significance. Further, AVcen (OR: 1.41; 95%CI: 1.04-1.95) and AASA (OR: 1.44; 95%CI: 1.21-1.77), especially AASA (area under curve: 66.6%), should be paid much more attention due to the higher OR than other indicators.
CONCLUSION
We have for the first time unveiled that AASA and age could be key risk factors for SFFFH, which further verifies that deficient anterior coverage of the acetabulum might be the main cause of SFFFH.
Core Tip: Our findings indicate that a small anterior acetabular sector angle (AASA) indicates poor anterior coverage of the femoral head and can increase the risk of subchondral fatigue fracture of the femoral head (SFFFH) in young patients. Since patients with a history of intense military training may be at higher risk for SFFFH, early detection and appropriate management are crucial to prevent further deterioration of the femoral head and preserve joint function. Based on these findings, we, therefore, recommend orthopedic surgeons not to exclude the possibility of SFFFH in patients who present with hip pain and have a history of intense military training, particularly if they have a small AASA.
