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<v ->The second case it's a...

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Let me put the images here.

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It's a 33-year-old male,

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presented with left hip pain after 2 hours walking

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on the beach sand.

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An MRI was requested and we can see,

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this is the MRI,

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was requested.

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As you can see the image in coronal and sagittal plane,

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both are T2 fat suppression sequences.

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It's easy,

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or we can see this impact impingement

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in the subchondral area

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with this kind of edema

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in the anterosuperior region,

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in the a lower area of the femoral head.

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It's easy to see,

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there is something wrong here.

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It's like a line in the,

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black line

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should be

1:00

read as a fracture.

1:03

And, as you told in your lecture,

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we can see this kind of edema.

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And usually this edema have a well stopped in the neck.

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It's a very well defined stop.

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This is very interesting.

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We have joint effusion.

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In this patient,

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three days after the first examination,

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the orthopedist request

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an MRI from the other side

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because he thought that this image was osteonecrosis,

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and he wants to see the other side,

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and the patient made the other side.

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In the other side, we can see some completely normal images

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without any problem, any bone problem.

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We can see the cartilage's good,

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the labrum is good, completely normal.

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This patient had a treatment.

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I don't know what has happened at this time.

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But two years

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after this first MRI he came back

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with pain in the,

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similar pain, in the right side.

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And the orthopedist asked us a bilateral,

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bilateral MRI.

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And for my surprise,

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look at,

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look at this.

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He did a surgery using two screws,

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metallic screws.

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I don't know why, don't ask me.

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This is a...

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It's a strong treatment.

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And this,

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the extremity of the screws touch the fovea,

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as you can see here.

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Luckily, the patient,

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cause if this extreme

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of the screws makes a rupture here,

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it'll be a catastrophe.

2:57

And if you take the images

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in T1 images.

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Let me put a zoom here.

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We can see this line.

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This is,

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it corresponds the healing fracture

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that we show before.

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Completely strong treatment,

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but the patient was asymptomatic.

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They didn't have any symptom in the side.

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But in the right side,

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what was normal?

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He came with the same problem that we saw

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in the left side.

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Means, he had another fracture.

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As we can see here, in the subchondral bone

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with the same pattern of edema go extending to the neck

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with joint effusion,

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without any cartilage or labrum lesion.

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Usually, these structures are cushioning structures.

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In this case,

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we don't have any problem with these structures.

3:59

Different that we see sometimes

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in the femoral condyle when we have a lesion

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of meniscus that I know that you are speaking about this.

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But we can see the line of fracture

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at the other side.

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That's it.

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Different places, different times.

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Is two years different

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between the first fracture

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in the left side for the right side.

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And I spoke with this guy,

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and I told him to do a bone densitometry,

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and he did.

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A few days, I call him and he told me

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that the densitometry result showed a reduction

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in the bone mass.

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He had good treatment at this time.

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I spoke with him.

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I didn't get in the problem of strong treatment,

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but I spoke with him and he had a very well treatment now,

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using calcium, rest and physiotherapy.

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And he's doing very well.

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You have any comment about this case?

5:01

Only to show different kinds of stress

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in substantial fractures.

5:06

<v ->No, but I think the one thing I would comment about,

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and I'm gonna talk a little bit

5:10

about reversible versus irreversible,

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is a bad prognostic sign is the flattening

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of the subchondral bone plate.

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That, once you get there,

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I'd be curious later on

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if he gets further collapse of that,

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of that femoral head,

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because he's already got a contour abnormality.

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But it's interesting.

5:34

So, migrating to the opposite side,

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this doesn't prove that the insufficiency fracture

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caused the marrow edema.

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But, you know, the association,

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clearly we know,

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you know?

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There's an association between the marrow edema

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and the insufficiency fracture.

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It's a very, very interesting case.

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So I,

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so I appreciate it.