Stress fractures of the pelvis

Abstract

Stress fractures are a very common overuse injury in the athletic population. Overall, these injuries consist of approximately 15—20 % of all visits to sports medicine clinics. A stress fracture not only leads to discomfort of the affected extremity but also can cause decreased athletic performance, lost training time, and medical expense. Pelvic stress fractures are less common than lower extremity stress fractures and can be divided based on location into: Sacral stress fractures, pubic ramus stress fractures, and iliac wing stress fractures as well as apophyseal avulsion fractures. These “low-risk†stress fractures generally present in female long distance runners and military recruits; however, these injuries should be considered in any athlete who experience repetitive loads to the axial skeleton. Diagnosis can be difficult and requires a high-level of suspicion as patients present with vague low back pain (sacral stress fractures) or groin discomfort. Radiographic evaluation can aid in diagnosis and consists of plain radiographs as well as advanced imaging such as magnetic resonance imaging (MRI) and/or bone scintigraphy. Treatment rarely requires operative management and involves cessation of the causative activity for 4—10 weeks with gradual return to physical activity. Additionally, any patient with a suspected pelvic stress fracture should undergo a metabolic evaluation consisting of blood and urine work as well as the intake of calcium and vitamin D. The purpose of this chapter is to evaluate the clinical presentation, evaluation, diagnostic tools, and management of stress fractures of the pelvis in the athletic population.