Pelvic insufficiency fracture in an osteoporotic 47-year-old female: a case report
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20240435Keywords:
Pelvic insufficiency fracture, Osteoporosis, Percutaneous screw fixation, Bisphosphonates, TeriparatideAbstract
Insufficiency fractures (IFs) represent a form of stress fractures frequently linked to osteoporosis and a lack of vitamin D. These fractures, which are not caused by trauma, typically manifest in the pelvis and spine, although occurrences in atypical locations are also relatively frequent. The primary methods for diagnosing IF involve using plain radiographs and magnetic resonance imaging scans, which are commonly employed imaging techniques. The management involves both medical and surgical methods, tailored as per the needs of the patient. 47-year-old female patient presented to the outpatient department with complaints of low back ache with waddling gait, with pain not responding to analgesics. Laboratory and radiological assessment revealed osteoporotic Insufficiency fracture in the pelvis which was managed with both surgical and medical methods, with surgical management involving percutaneous screw fixation of the fractures. Diagnosis of the osteoporotic insufficiency fractures at atypical locations can be extremely challenging because of the inconclusive radiographs and the lack of a perceptible trauma history and hence, can be missed at the initial presentation. The management includes both operative and non-operative modalities, best tailored as per the patient needs and expectations.
References
Varshney MK. Essential Orthopedics: Principles and Practice - 2nd Edition - Volume 1 and 2. Jaypee Brothers Medical Publishers (P) Ltd. 2022.
Hoshino Y, Doita M, Yoshikawa M, Hirayama K, Sha N, Kurosaka M. Unstable pelvic insufficiency fracture in a patient with rheumatoid arthritis. Rheumatol Int. 2004;24 (1):46-9.
Peh WC, Gough AK, Sheeran T, Evans NS, Emery P. Pelvic insufficiency fractures in rheumatoid arthritis. Br J Rheumatol. 1993;32(4):319-24.
Moreno A, Clemente J, Crespo C. Pelvic insufficiency fractures in patients with pelvic irradiation. Int J Radiat Oncol Biol Phys. 1999;44(1):61-6.
Baxter NN, Habermann EB, Tepper JE, Durham SB, Virnig BA. Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005;294(20):2587-93.
Marmor L. Stress fracture of the pubic ramus stimulating a loose total hip replacement. Clin Orthop Relat Res. 1976;121:103-4.
Smith D, Zuckerman JD. Bilateral stress fractures of the pubic rami following THA—an unusual case of groin pain. Bull NYU Hosp Jt Dis. 2010;68(1):43-5.
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the united states, 2005-2025. J Bone Miner Res. 2007;22(3):465-75.
Tsiridis E, Upadhyay N, Giannoudis P. Sacral insufficiency fractures: current concepts of management. Osteoporosis Int. 2006;17(12):1716-25.
Cabarrus MC, Ambekar A, Lu Y, Link TM. MRI and CT of insufficiency fractures of the pelvis and the proximal femur. AJR Am J Roentgenol. 2008;191(4):995-1001.
Henes FO, Nuchtern JV, Groth M, Habermann CR, Regier M, Rueger JM, et al. Comparison of diagnostic accuracy of magnetic resonance imaging and multidetector computed tomography in the detection of pelvic fractures. Eur J Radiol. 2012;81(9):2337-42.
Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. fracture intervention trial research group. Lancet. 1996;348(9041):1535-41.
Body JJ, Gaich GA, Scheele WH, Kulkarni PM, Miller PD, Peretz A, et al. A randomized double blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1-34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab. 2002;87(10):4528-35.
Dempster DW, Cosman F, Kurland ES, Zhou H, Nieves J, Woelfert L, et al. Effects of daily treatment with parathyroid hormone on bone microarchitecture and turnover in patients with osteoporosis: a paired biopsy study. J Bone Miner Res. 2001;16(10):1846-53.
Frey ME, Depalma MJ, Cifu DX, Bhagia SM, Carne W, Daitch JS. Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study. Spine J. 2008;8(2):367-73.
Bayley E, Srinivas S, Boszczyk BM. Clinical outcomes of sacroplasty in sacral insufficiency fractures: a review of the literature. Eur Spine J. 2009;18(9):1266.
