Bilateral Stress Fractures of Pubic Ramus in a Patient affected by Hyperparathyroidism

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This case report presents a 48-year-old patient who was diagnosed of bilateral pubic ramus stres fracture in one year period. She was admitted with hip and groin pain. In our case, direct radiography followed by MRI was used for diagnosis. Hyperparathyroidism was detected as a etiological cause. Patient underwent conservative treatment for bilateral stres fractures of pubic ramus with perfect results. Attending to this case report, in patients with non-traumatic groin pain and endocrinological disorders, pubic ramus stress fracture is a diagnosis that should be kept in mind.

Stress fractures are those that occur in a local area of a normal or pathologic bone, due to less powerful forces that will normally result in a complete fracture. This kind of fractures are divided into three different subgroups: fatigue fracture, insufficiency fracture, and pathologic fracture. Fatigue fractures occur in healthy bones due to unusual mechanical effect. Their prevalency is increased in young adults, especially in weight bearing bones. Attending to the risk factors, fatigue fractures are most frequenly observed in athletes, dancers, and soldiers. On the other hand, insufficiency fractures occurs as a result of reduced bone resistance under normal bearing. Many clinical risk factors have been identified with this fracture type, including osteoporosis, osteomalacia, hyperparathyroidism, rheumatoid arthritis, long term use of cortisone, diabetes mellitus, fibrous dysplasia, renal insufficiency, and radiotherapy.

Attending to insufficiency fractures, most pelvic insufficiency fractures occur in women, particularly those with osteoporotic bone. They represent, approximately, 1-2% of all the stress fractures, and they most commonly observed at the pubic ramus. This kind of fractures are usually asymptomatic; nevertheless, these patients ay present groin and back pain. For our knowledge, bilateral pubic ramus stress fracture due to hyperparathyroidism has not been reported previously. In this case report, we present a case report of a female patient affected of this type of fracture and realize a short review about of stress fractures in patients affected of endocrinological mineral balance disorders, including hyperparathyroidism.