Atraumatic Subcapital Femoral Neck Fracture as the Initial Presentation of Osteonecrosis of the Femoral Head: A Case-Based Systematic Review.
- 1Department of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand.
- 2Department of Orthopedics, Faculty of Medicine, Kasetsart University, Bangkok, Thailand.
Abstract
Objective
Atraumatic subcapital femoral neck fracture associated with osteonecrosis of the femoral head (ONFH) is rare and may be difficult to recognize before surgery, while the available evidence regarding its diagnosis and management remains limited. We therefore aimed to describe an atypical presentation of ONFH as an atraumatic subcapital femoral neck fracture and to synthesize the available evidence on its diagnostic features, treatment patterns, and outcomes through a systematic review.Methods
A CARE-compliant case report was combined with a PRISMA 2020-guided systematic review registered in PROSPERO. MEDLINE, Embase, Cochrane CENTRAL, and Scopus were searched from inception to February 28, 2026, for reports of atraumatic subcapital or transcervical femoral neck fractures associated with ONFH. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the appropriate Joanna Briggs Institute critical appraisal checklists. Findings were synthesized descriptively because of substantial clinical heterogeneity and the absence of comparative studies.Results
Eighteen studies involving 50 patients (58 fractured hips) were included. Magnetic resonance imaging (MRI) was reported in 38 of 50 patients (76%). Reported primary-treatment failures occurred in 3 of 8 internally fixed hips and 1 of 41 hips treated with arthroplasty; however, these uncontrolled descriptive findings do not permit comparative or causal inference.Conclusions
ONFH should be considered in atraumatic femoral neck fractures with atypical radiographic features. The available evidence is insufficient to determine the comparative effectiveness of arthroplasty and internal fixation, and treatment decisions should therefore remain individualized.
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BibTeX
@article{plangsiri2026atraumatic,
title = {{Atraumatic Subcapital Femoral Neck Fracture as the Initial Presentation of Osteonecrosis of the Femoral Head: A Case-Based Systematic Review.}},
author = {Komson Plangsiri and Wittawat Boonyanuwat and Pinkawas Kongmalai},
journal = {Orthopaedic surgery},
year = {2026},
month = oct,
doi = {10.1111/os.70445},
url = {https://europepmc.org/article/MED/42959007},
note = {CC BY},
}
RIS
TY - JOUR
TI - Atraumatic Subcapital Femoral Neck Fracture as the Initial Presentation of Osteonecrosis of the Femoral Head: A Case-Based Systematic Review.
AU - Komson Plangsiri
AU - Wittawat Boonyanuwat
AU - Pinkawas Kongmalai
PY - 2026
DA - 2026/10/30
JO - Orthopaedic surgery
DO - 10.1111/os.70445
UR - https://europepmc.org/article/MED/42959007
AB - Objective Atraumatic subcapital femoral neck fracture associated with osteonecrosis of the femoral head (ONFH) is rare and may be difficult to recognize before surgery, while the available evidence regarding its diagnosis and management remains limited. We therefore aimed to describe an atypical presentation of ONFH as an atraumatic subcapital femoral neck fracture and to synthesize the available evidence on its diagnostic features, treatment patterns, and outcomes through a systematic review.Methods A CARE-compliant case report was combined with a PRISMA 2020-guided systematic review registered in PROSPERO. MEDLINE, Embase, Cochrane CENTRAL, and Scopus were searched from inception to February 28, 2026, for reports of atraumatic subcapital or transcervical femoral neck fractures associated with ONFH. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the appropriate Joanna Briggs Institute critical appraisal checklists. Findings were synthesized descriptively because of substantial clinical heterogeneity and the absence of comparative studies.Results Eighteen studies involving 50 patients (58 fractured hips) were included. Magnetic resonance imaging (MRI) was reported in 38 of 50 patients (76%). Reported primary-treatment failures occurred in 3 of 8 internally fixed hips and 1 of 41 hips treated with arthroplasty; however, these uncontrolled descriptive findings do not permit comparative or causal inference.Conclusions ONFH should be considered in atraumatic femoral neck fractures with atypical radiographic features. The available evidence is insufficient to determine the comparative effectiveness of arthroplasty and internal fixation, and treatment decisions should therefore remain individualized.
SN - 1757-7853
SN - 1757-7861
ER -