Recently, the diagnosis of occult frac- tures has been facilitated due to
increased availability and utilization of MRI. Diagnosing a fracture of the
ischiopubic rami from a proximal femoral fracture, in particular, is difficult
using physical exam alone and can be facilitated by having access to an MRI.
Here we report both physical exam findings and MRI findings that help in
differentiating occult fractures of the iliopubic rami. Materials and Methods:
From April 2010 to December 2012, we identified 30 pa- tients (5 male and 25
female; aged 43 - 93 years old). We recorded if a traumatic episode occurred,
ambu- latory status at the initial visit (bed ridden, standing up with an aid,
walking with an aid). We also re- corded if imaging was used in determining the
final diagnosis (radiographs, MRI or CT).
Results: Twenty- one patients had a fracture as a result of a traumatic
episode. In the remaining 9 cases, no trauma oc- curred and therefore the
fractures were insufficiency fractures. Ten patients were bed ridden at the
initial visit, eight patients were able to stand only with a walking aid, and
the remaining twelve patients were able to walk with an aid. Occasional
radiographs were used to confirm the presence of a fracture in 4 cases, MRI in
11 cases, and CT scan in 15 cases. Dis- cussion and Conclusions: Occult
fractures of the is- chiopubic rami can occur without trauma and it can be
difficult to differentiate these fractures from occult proximal femoral
fractures. In these cases, MRI is useful to definitively obtain a diagnosis. In
cases of pacemaker, bullet implantation or artificial hip joints, CT or
occasional radiographs are also useful to diag- nose occult fractures of the
Iwata, T., Nozawa, S., Dohjima, T., Yamamoto, T., Ishimaru, D., Tsugita, M., Maeda, M. and Shimizu, K. (2012) The value of T1-weighted coronal MRI scans in diagnosing occult fracture of the hip. Journal of Bone and Joint Surgery (British Volume), 94, 969-973.
Sankey, R.A., Turner, J., Lee, J., Healy, J. and Gibbons, C.E.R. (2009) The use of MRI to detect occult fractures of the proximal femur. Journal of Bone and Joint Surgery (British Volume), 91, 1064-1068.
Ganiyusufoglu, A.K., Onat, L., Karatoprak, O., Enercan, M. and Hamzaoglu, A. (2010) Diagnostic accuracy of magnetic resonance imaging versus computed tomography in stress fractures of the lumbar spine. Clinical Radiology, 65, 902-907. doi:10.1016/j.crad.2010.06.011
Cabarrus, M.C., Ambekar, A., Lu, Y. and Link, T.M. (2008) MRI and CT of insufficiency fractures of the pelvis and the proximal femur. American Journal of Roentgenology, 191, 995-1001. doi:10.2214/AJR.07.3714
Christiansen, C.G., Kassin, R.A., Callaghan, J.J., et al. (2003) Pubic ramus insufficiency fractures following total hip arthroplasty: A report of six cases. Journal of Bone and Joint Surgery (American Volume), 85, 1819-1822.
Tsuboi, M., Hasegawa, Y., Fujita, K. and Kawabe, K. (2011) Pubic/ischial stress fractures after eccentric rotational acetabular osteotomy. Journal of Orthopaedic Science, 16, 38-43. doi:10.1007/s00776-010-0010-6
Lee, S.W. and Lee, C.H. (2005) Fatigue stress fractures of the pubic ramus in the army: Imaging features with radiographic, scintigraphic and MR imaging findings. Korean Journal of Radiology, 6, 47-51.
Beall, D.P., Datir, A., D’Souza, S.L., D’Souza, L.S., Gunda, D., Morelli, J., Johnson, M.B. and Nabavizadeh, N. (2010) Percutaneous treatment of insufficiency fractures: Principles and review of literature. Skeletal Radiology, 39, 117-130. doi:10.1007/s00256-009-0722-x