Herniation pit of the femoral neck

American Journal of Roentgenology (Impact Factor: 2.74). 07/1982; 138(6):1115-21. DOI: 10.2214/ajr.138.6.1115
Source: PubMed

ABSTRACT A round to oval radiolucency surrounded by a thin zone of sclerosis is often identified in the proximal superior quadrant of adult femoral necks. Although usually recognized as incidental and benign, these radiolucencies may be of clinical concern in patients with hip symptoms. The true nature and genesis of these radiolucencies have not been explained. This article relates these radiolucencies to common acquired degenerative changes developing on the surface of the femoral neck in adults (the reaction area) and shows that the radiolucency represents a subcortical pit or cavity formed by herniation of soft tissue contents through defects in the surface of the reaction area. The formation of this pit and its relation to the commonly seen femoral neck radiolucency has not been previously described. The name "herniation pit" is suggested for these lesions.

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    • "Bone notch (Poirier, 1911) Capsular crest (Walmsley, 1915) Cervical crest (Meyer, 1934) Crest Herniation pit (Pitt, 1982) Fibrocystic changes (Leunig, 2005) The notch sign (Petchprapa, 2012) Cervical fossa (Allen, 1882) Irregular depression (Parsons, 1914) Capsular sulcus (Walmsley, 1915) Beta-type Poirirer's facet (Pearson, 1919) Irregular fossa (Meyer, 1934) Trace (Schofield, 1959) Anterior cervical trace (Kostick, 1963) Allen's fossa (Angel, 1964) "
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    • "Femoral factors liable to induce AFAI were assessed on lateral neck view, whether Dunn's, Ducroquet's or a variant of these (Table 3): anterosuperior neck dysmorphy (flat, arched or osteophytic: Fig. 6), ovoid femoral head, and alpha angle (Fig. 7) [3]. Lesions secondary to HOA and/or AFAI were also assessed: hip joint narrowing, notch, condensation or neck cyst (Fig. 8) [1]. Cross-sectional imaging, whether arthroscan or arthro- MR, assessed factors liable to induce AFAI 7—9, whether femoral (alpha angle: Fig. 9) or acetabular (acetabular opening: normal in case of acetabular anteversion, pathologic Table 1 Factors liable to induce AFAI and/or HOA on AP standing pelvic X-ray. "
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    ABSTRACT: Two hundred and ninety-two patients under the age of 50 years, presenting with mechanical hip pain, were included in a prospective multicenter study. In 241 cases, imaging assessment included AP standing pelvic X-ray and Lequesne's false profile (LFP) and/or lateral neck (Ducroquet, Dunn or variant) hip X-ray. Cross-sectional arthroscan and/or arthro-MRI images were available in 81 cases. Exploration looked for acetabular and femoral head/neck dysplasia liable to induce cam or pincer anterior femoroacetabular impingement (AFAI), respectively. Labral and chondral lesions arise secondarily to hip osteoarthritis (HOA) and/or AFAI. Two-thirds of patients showed HOA. Only 6% showed a strictly normal aspect on imaging. More than half (52%) of cases had cam AFAI, half of these involving an osteophytic neck, associated in more than 90% of cases with large multifocal bone spurs of the head, neck and acetabula. These cases were considered ambiguous, due to the uncertainty as to the congenital nature of the cervico-cephalic dysmorphy; if they are excluded, only 23% of the series involved cam AFAI. Crossover sign on AP standing pelvic X-ray is the best assessment criterion for acetabular retroversion, the most frequent form of acetabular dysplasia underlying pincer AFAI, and should be explored for. Secondary neck lesions were visible only on lateral neck view in 42% of cases: this view should be included in standard radiologic work-up in under-50 year-olds. The alpha angle can be measured on this type of lateral view and on axial arthroscan and arthro-MR images; more than half of the cases in which it was pathological involved an osteophytic neck and thus a pseudo-cam effect.
    Orthopaedics & Traumatology Surgery & Research 10/2010; 96(8 Suppl):S44-52. DOI:10.1016/j.otsr.2010.09.008 · 1.17 Impact Factor
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    • "Until Ganz et al. first described femoroacetabular impingement , mechanical hip pathology was mainly imputed to dysplasia or other causes such as coxa profunda or caput varum, or else often considered idiopathic [1]. Described as a femoral (cam effect), acetabular (pincer effect) or mixed morphologic abnormality, impingement accounts for certain joint lesions found in young athletic patients: labrum lesion, cartilage lesion, bone remodeling of the periphery of the acetabulum or bone cysts of the cervicocephalic junction [2] [3]. Due to the causal relation between impingement morphotype and joint lesion, the syndrome is also implicated in the genesis of osteoarthritis of the hip [2] [4]. "
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    ABSTRACT: Two hundred and ninety-two patients, aged between 16 and 50 years and presenting with mechanical hip pathology, were included in a prospective multicenter study. The descriptive study concerned the clinical examination and analysis of three X-ray views (AP pelvic, Lequesne false profile and lateral axial view). The series comprised 62% males, mean age 35 years, with 53% right side and 22% bilateral involvement. Initial trauma was reported in 19% of cases, and direct familial history of hip pathology in 20%. Seventy percent of the patients played sports, 30% were high-level athletes, and 17% played combat sports. The physical impingement sign was present in 18% to 65% of cases depending on the variant studied. On imaging (n=241), 62% of hips showed osteoarthritis, with 25% at the evolved stage. In the series, as a whole, there was a 35% rate of dysplasia, 63% of impingement and 5% of normal X-ray results. The radiologic impingement aspects were 58% cam-type, 19% pincer-type and 23% mixed. Twenty-two percent of dysplasia cases showed signs of associated impingement. Pain experienced exclusively in flexion/internal rotation/adduction on examination showed little sensitivity (20%) but considerable specificity (86%) for the main diagnosis of impingement. The links between impingement and dysplasia are discussed, and an integrative schema of all risk factors is put forward.
    Orthopaedics & Traumatology Surgery & Research 10/2010; 96(8 Suppl):S53-8. DOI:10.1016/j.otsr.2010.09.005 · 1.17 Impact Factor
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