Osteosynthesis in a Pubic Stress Fracture. Case Report and Literature Review
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Published:
Aug 19, 2021
Keywords:
Stress fracture, pubis, osteosynthesis
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Abstract
Background: Pubic stress fracture (PSF) is a rare condition, described in long-distance runners and military recruits. One hundred and ninety-three conservatively managed cases have been documented in the literature. The purpose of this paper is to report an alternatively resolved case and to review previously reported cases, associated pathologies, diagnosis, and treatment. We report a case of an elderly patient, sportingly active, with PSF, who did not respond to conservative treatment and was surgically treated.Follow-up of the patient was favorable with remission of pain and return to activities. The indication for treatment should not be limited only to the degree of instability of the fracture, but should also take into account the medical and social context of the patient.
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How to Cite
Carabajal Mattar, M., & Schumacher, F. (2021). Osteosynthesis in a Pubic Stress Fracture. Case Report and Literature Review. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(4), 537-544. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1214
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Case Presentations
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References
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definition, diagnosis and treatment. Rev Bras Ortop 2016;51(1):3-10. https://doi.org/10.1016/j.rboe.2015.12.008
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https://doi.org/10.1097/01.csmr.0000306294.72578.a8
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12. Bertolini FM, Vieira RB, Araujo de Oliveira LH, Lasmar RP, Taviano de Oliveira J. Pubis stress fracture in a 15 year old soccer player. Rev Bras Ortop 2011;46(4):464-7. https://doi.org/10.1016/S2255-4971(15)30263-9
13. Tacettin Ayanaoğlu, O Şahap Atik, Nil Tokgöz, Murat Uçar. Sacral and pubic insufficiency fractures due to
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14. Ragnarsson B, Jacobsson B. Epidemiology of pelvic fractures in a Swedish county. Acta Orthop
Scand 1992;63:297-300. https://doi.org/10.3109/17453679209154786
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association with pubic rami fractures. Clin Rheumatol 2000;19:399-401. https://doi.org/10.1007/pl00011178
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17. Marshall C, Gringmuth R. Pubic stress fracture presenting as a strain of adductor longus in a 16-year-old elite
soccer player with Crohn’s disease: a case report. J Can Chiropr Assoc 2019;63(3):19-204. PMID: 31988541
18. Daffner RH, Pavlov H. Stress fractures: current concepts. Am J Roentgenol 1992;159(2):245-52.
https://doi.org/10.2214/ajr.159.2.1632335
19. Garras DN, Carothers JT, Olson SA. Single-leg-stance (Flamingo) radiographs to assess pelvic instability: how
much motion is normal? J Bone Joint Surg Am 2008;90(10):2114-8. https://doi.org/10.2106/JBJS.G.00277
20. Raasch WG, Hergan DJ. Treatment of stress fractures: the fundamentals. Clin Sports Med 2006;25(1):29-36.
https://doi.org/10.1016/j.csm.2005.08.013
21. Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury 2013;44(12):1733-44. https://doi.org/10.1016/j.injury.2013.06.023
22. Taillandier J, Langue F, Alemanni M, Taillandier-Heriche E. Mortality and functional outcomes of pelvic
insufficiency fractures in older patients. Joint Bone Spine 2003;70:287-9. https://doi.org/10.1016/s1297-319x(03)00015-0
23. Spencer JL, Lalanadham T. The mortality of patients with minor fractures of the pelvis. Injury 1985;16:321-3.
https://doi.org/10.1016/0020-1383(85)90136-6
24. Höch A, Özkurtul O, Pieroh P, Josten C, Böhme J. Outcome and 2-year survival rate in elderly patients with lateral compression fractures of the pelvis. Geriatr Orthop Surg Rehabil 2017;8:3-9. https://doi.org/10.1177/2151458516681142
2. Snyder RA, Koester MC, Dunn WR. Epidemiology of stress fractures. Clin Sports Med 2006;25(1):37-52.
https://doi.org/10.1016/j.csm.2005.08.005
3. Miller C, Major N, Toth A. Pelvic stress injuries in the athlete. Sports Med 2003;33:1003-12. https://doi.org/10.2165/00007256-200333130-00005
4. Carmont RC, Mei-Dan O, Bennell KL. Stress fracture management: current classification and new healing
modalities. Oper Tech Sports Med 2009;17:81-9. https://doi.org/10.1053/j.otsm.2009.05.004
5. Quinteros C. Fractura por estrés de rama iliopubiana - Reporte de caso. Revista de la Facultad de Ciencias Médicas de Córdoba 2018;135-6. https://doi.org/10.31053/1853.0605.v0.n0.21473
6. Bennell KL, Malcolm SA, Thomas SA, Wark JD, Brukner PD. The incidence and distribution of stress fractures in
competitive track and field athletes. A twelve-month prospective study. Am J Sports Med 1996;24(2):211-7.
https://doi.org/10.1177/036354659602400217
7. Costa Astur D, Zanatta F, Gonçalves Arliani G, Moraes ER, de Castro Pochini A, Ejnisman B. Stress fractures:
definition, diagnosis and treatment. Rev Bras Ortop 2016;51(1):3-10. https://doi.org/10.1016/j.rboe.2015.12.008
8. Dauty M, Collon S. Incidence of injuries in French professional soccer players. Int J Sports Med 2011;32(12):965-9. https://doi.org/10.1055/s-0031-1283188
9. Pepper M, Akuthota V, McCarty EC. The pathophysiology of stress fractures. Clin Sports Med 2006;25(1):1-6.
https://doi.org/10.1016/j.csm.2005.08.010
10. Joy EA, Campbell D. Stress fractures in the female athlete. Curr Sports Med Rep 2005;4(6):323-8.
https://doi.org/10.1097/01.csmr.0000306294.72578.a8
11. Henning PT. The running athlete: stress fractures, osteitis pubis, and snapping hips. Sports Health 2014;6(2):122-7. https://doi.org/10.1177/1941738114523381
12. Bertolini FM, Vieira RB, Araujo de Oliveira LH, Lasmar RP, Taviano de Oliveira J. Pubis stress fracture in a 15 year old soccer player. Rev Bras Ortop 2011;46(4):464-7. https://doi.org/10.1016/S2255-4971(15)30263-9
13. Tacettin Ayanaoğlu, O Şahap Atik, Nil Tokgöz, Murat Uçar. Sacral and pubic insufficiency fractures due to
bisphosphonate treatment. Eklem Hastalik Cerrahisi 2015;26(2):120-4. https://doi.org/10.5606/ehc.2015.23
14. Ragnarsson B, Jacobsson B. Epidemiology of pelvic fractures in a Swedish county. Acta Orthop
Scand 1992;63:297-300. https://doi.org/10.3109/17453679209154786
15. Aretxabala I, Fraiz E, Pérez-Ruiz F, Ríos G, Calabozo M, Alonso-Ruiz A. Sacral insufficiency fractures. High
association with pubic rami fractures. Clin Rheumatol 2000;19:399-401. https://doi.org/10.1007/pl00011178
16. Dummar AR, Tragord B, Doherty BT. Plexiform neurofibromatosis in a woman with a pubic ramus stress fracture. J Orthop Sports Phys Ther 2019;49(1):37. https://doi.org/10.2519/jospt.2019.7495
17. Marshall C, Gringmuth R. Pubic stress fracture presenting as a strain of adductor longus in a 16-year-old elite
soccer player with Crohn’s disease: a case report. J Can Chiropr Assoc 2019;63(3):19-204. PMID: 31988541
18. Daffner RH, Pavlov H. Stress fractures: current concepts. Am J Roentgenol 1992;159(2):245-52.
https://doi.org/10.2214/ajr.159.2.1632335
19. Garras DN, Carothers JT, Olson SA. Single-leg-stance (Flamingo) radiographs to assess pelvic instability: how
much motion is normal? J Bone Joint Surg Am 2008;90(10):2114-8. https://doi.org/10.2106/JBJS.G.00277
20. Raasch WG, Hergan DJ. Treatment of stress fractures: the fundamentals. Clin Sports Med 2006;25(1):29-36.
https://doi.org/10.1016/j.csm.2005.08.013
21. Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury 2013;44(12):1733-44. https://doi.org/10.1016/j.injury.2013.06.023
22. Taillandier J, Langue F, Alemanni M, Taillandier-Heriche E. Mortality and functional outcomes of pelvic
insufficiency fractures in older patients. Joint Bone Spine 2003;70:287-9. https://doi.org/10.1016/s1297-319x(03)00015-0
23. Spencer JL, Lalanadham T. The mortality of patients with minor fractures of the pelvis. Injury 1985;16:321-3.
https://doi.org/10.1016/0020-1383(85)90136-6
24. Höch A, Özkurtul O, Pieroh P, Josten C, Böhme J. Outcome and 2-year survival rate in elderly patients with lateral compression fractures of the pelvis. Geriatr Orthop Surg Rehabil 2017;8:3-9. https://doi.org/10.1177/2151458516681142