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Case Reports
. 2017 Jul-Aug;7(4):76-79.
doi: 10.13107/jocr.2250-0685.862.

Insufficiency Fractures at Unusual Sites: A Case Series

Raju Vaishya  1 , Amit Kumar Agarwal  1 , Paras Kumar Banka  1 , Vipul Vijay  1 , Abhishek Vaish  1
Affiliations
Case Reports

Insufficiency Fractures at Unusual Sites: A Case Series

Raju Vaishya et al. J Orthop Case Rep. 2017 Jul-Aug.

Abstract

Introduction: Insufficiency fractures (IFs) are a subtype of stress fractures commonly associated with osteoporosis and Vitamin D deficiency. These nontraumatic fractures often occur in the pelvis and spine, but the involvement of other unusual sites is also not very uncommon. Plain radiographs and magnetic resonance imaging scan are the most commonly used imaging modalities for the diagnosis of IF.

Case report: We are presenting a series of five cases of IFs at unusual sites, along with a detailed literature review on this individual. A 50-year-old male patient with chronic kidney disease presented with both femoral neck and right lesser trochanter IF which was managed with cannulated screws. A 53-year-old male patient on steroid presented with sternum IF. A 26-year-old male patient presented with Vitamin D deficiency and accessory navicular IF. A 60-year-old female on bisphosphonate therapy came with bilateral femoral shaft fracture. All these three patients were managed conservatively. Another 62-year-old male patient with rheumatoid arthritis presented with sacrum IF which was managed with cannulated screw fixation.

Conclusion: IFs are a subtype of stress fractures commonly associated with osteoporosis and Vitamin D deficiency. A good clinical examination along with proper radiological investigation facilitates early diagnosis of IF in the osteoporotic bone. An early diagnosis helps in deciding the definitive course of treatment and to obtain a good result. An undisplaced fracture can be managed nonoperatively by treating the underlying medical cause, but fractures at the risk of displacement or a displaced fracture may need operative treatment.

Keywords: Insufficiency fracture; Vitamin D deficiency; bone; osteoporosis; stress fracture.

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Figures

Figure 1
Figure 1
(a) Computed tomography (CT scan) coronal view of pelvis showing bilateral femoral neck insufficiency fractures (IFs) with right lesser trochanter fracture. (b) CT scan coronal view of pelvis showing right lesser trochanter insufficiency fracture. (c) Post-operative X-ray of pelvis showing bilateral femoral neck IF fixed with cannulated screws.
Figure 2
Figure 2
Lateral X- Ray of the sternum showing an IF in the body of the sternum.
Figure 3
Figure 3
(a) Computed tomography (CT) scan (Sagittal view) of pelvis showing insufficiency fractures (IF) of the sacrum. (b) CT scan (Coronal view) of pelvis showing IF of the right side of the sacrum. (c) X-ray of pelvis showing fixation of IF of the sacrum.
Figure 4
Figure 4
X-ray and CT scan of a foot showing insufficiency fractures in the accessory navicular.
Figure 5
Figure 5
X-ray of the pelvis and both femurs (anteroposterior view) showing insufficiency fractures of the right shaft and left the sub-trochanteric region
See this image and copyright information in PMC

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