Insufficiency fractures of the pubic ramus

• Published in: Seminars in arthritis and rheumatism 1996-06, Vol.25 (6), p.373-382
• Main Authors: Schapira, Daniel, Militeanu, Daniela, Israel, Ora, Scharf, Yehuda
• Format: Article
• Language: English
• Subjects: Aged; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Arthritis, Rheumatoid - complications; Biological and medical sciences; Bone Diseases, Metabolic - complications; Calcitonin - therapeutic use; Female; Fractures, Stress - diagnosis; Fractures, Stress - etiology; Fractures, Stress - therapy; Humans; Injuries of the limb. Injuries of the spine; insufficiency fracture; Kidney Failure, Chronic - complications; Medical sciences; Middle Aged; osteoporosis; Osteoporosis - complications; Prognosis; Pubic Bone - diagnostic imaging; Pubic Bone - injuries; pubis; Radionuclide Imaging; Risk Factors; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; Treatment Outcome
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/S0049-0172(96)80002-3

Seven elderly women with insufficiency fractures of the pubic ramus are described. The predisposing factors for this condition were osteoporosis, rheumatoid arthritis, renal failure, prolonged corticosteroid treatment, pelvic irradiation, and mechanical changes after hip surgery. The clinical presentation included progressive inguinal pain, limping, and inability to walk. Because initial radiographs were diagnostic only in four cases, bone scintigraphy and computed tomography were necessary to confirm the diagnosis and detect additional fractures. In most patients, bed rest, non-weight-bearing ambulation, symptomatic treatment, and therapy for osteoporosis resulted in rapid improvement, and long-term follow-up showed complete or partial recovery. In one case, no recovery was achieved because of noncompliance with treatment. Insufficiency fracture of the pubic ramus should be suspected in cases of unexplained inguinal or hip-area pain and inability to walk in the elderly. The clinical suspicion should be supplemented by radiological investigation. Bone scintigraphy and computed tomography are useful means for early and accurate diagnosis. The risk factors for this condition should be identified and treated. If therapy is initiated early and pursued, this type of fracture has a benign outcome.