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Pelvic Stress Fracture

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Other Names

  • Pubic Ramus Stress Fracture
  • Inferior Pubic Rami Stress Fracture

Background

  • This page refers to stress fractures of the Pubic Rami, often referred to as pelvic stress fracture

History

  • Described in military recruits as early as 1937[1]

Epidemiology

  • Represent only 1.6% - 5.6% of lower extremity stress fractures[2][3]

Pathophysiology

Pathoanatomy


Risk Factors


Differential Diagnosis

Differential Diagnosis Hip Pain

Differential Diagnosis Groin Pain


Clinical Features

  • History
    • Reports groin or hip pain
  • Physical Exam: Physical Exam Hip
    • Sacral: tenderness along the sacrum or SI joint
  • Special Tests

Evaluation

Radiographs

MRI

  • Gold standard for evaluating suspected stress fractures
  • Sensitivity 42%, specificity 100% for pelvic stress fractures
    • Sensitivity much lower than other stress fractures[9]

CT

  • More useful for pelvis given low sensitivity of MRI
  • Helpful for surgical planning

Bone Scan

  • Has fallen out of favor for MRI due to poor specificity

Classification

  • N/A

Management

Prognosis

  • Pelvic stress fractures take 6-12 months of recovery, which is substantially longer than the 2-3 months required by stress fractures at other sites[10]

Nonoperative

  • Patients require rest
    • Relative rest may be insufficient due to prolonged recovery times
    • May require non-weight bearing status

Operative

  • N/A

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play

  • Guided by pain

Complications

  • Inability to return to sport

See Also


References


  1. . Wachsmuth W: Zur atlologtc der schleichenden frakturen. Der Chirung 1937; 9: 16-24.
  2. Wentz, Laurel, et al. "Females have a greater incidence of stress fractures than males in both military and athletic populations: a systemic review." Military medicine 176.4 (2011): 420-430.
  3. Matheson, G. O., et al. "Stress fractures in athletes: a study of 320 cases." The American journal of sports medicine 15.1 (1987): 46-58.
  4. Ha KI, Hahn SH, Chung MY, et al. A clinical study of stress fractures in sports activities. Orthopedics 1991;14(10):1089–95.
  5. Southam, Jodi D., Matthew L. Silvis, and Kevin P. Black. "Sacral stress fracture in a professional hockey player." Orthopedics 33.11 (2010).
  6. Crockett, Heber C., et al. "Sacral stress fracture in an elite college basketball player after the use of a jumping machine." The American journal of sports medicine 27.4 (1999): 526-528.
  7. Silva, R. T., et al. "Sacral stress fracture: an unusual cause of low back pain in an amateur tennis player." British journal of sports medicine 40.5 (2006): 460-461.
  8. Shah, Mrugeshkumar K., and Gregory W. Stewart. "Sacral stress fractures: an unusual cause of low back pain in an athlete." Spine 27.4 (2002): E104-E108.
  9. Berger FH, de Jonge MC, Maas M. Stress fractures in the lower extremity: the importance of increasing awareness amongst radiologists. Eur J Radiol. 2007;62(1):16-26
  10. Matheson GO, Clement DB, McKenzie JE, et al: Stress fractures in athletes: a study of 320 cases. Am J Sports Med 1987; 15: 46-58.
Created by:
John Kiel on 6 July 2020 15:39:45
Authors:
Last edited:
21 December 2020 13:51:45
Categories:
Lower Extremity | Groin | Hip | Fractures | Overuse