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Subchondral insufficiency fracture of the femoral head in a patient with systemic lupus erythematosus
  1. T Yamamoto1,
  2. R Schneider2,
  3. Y Iwamoto1,
  4. P G Bullough3
  1. 1Department of Orthopaedic Surgery, Kyushu University, Japan
  2. 2Department of Radiology, Hospital for Special Surgery, New York, USA
  3. 3Department of Laboratory Medicine, Hospital for Special Surgery, New York, USA
  1. Correspondence to:
    Dr P G Bullough
    Department of Laboratory Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; bulloughp{at}hss.edu

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Osteonecrosis of the femoral head (ON) has been recognised as a relatively common complication in patients with systemic lupus erythematosus (SLE) who have received corticosteroids, with a reported prevalence of around 30%.1 Recently, subchondral insufficiency fracture of the femoral head (SIF) has been reported as a differential diagnosis in patients suspected of having osteonecrosis.2–4 We describe the clinicopathological features of a patient with SLE with a history of corticosteroid treatment, who developed SIF.

A 55 year old woman had a 32 year history of SLE, which had been treated with corticosteroids (8 mg/day). She had a history of hypothyroidism, arthritis in both shoulders, skin rash, pericarditis, and pleuritis, but had no history of smoking or drinking. The body mass index indicated she was overweight (27.4 kg/m2).

Over the past 5 years she had developed stiffness and discomfort in the right hip, and over the past 2 months the hip pain had got worse. …

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