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Pelvis Stress Fractures
MK Jesse, MD; Julia R. Crim, MD; Andrew Sonin, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Fatigue fracture, overuse fracture, insufficiency fracture, fragility fracture
            • Definitions

              • Fatigue fracture: repetitive overuse trauma results in failure of normal bone
              • Insufficiency fracture: normal activity results in failure of weakened (usually osteoporotic) bone
                • Also called fragility fracture

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            • Reporting Tips

                                              Selected References

                                              1. Matcuk GR Jr et al: Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol. 23(4):365-75, 2016
                                              2. Changstrom BG et al: Epidemiology of stress fracture injuries among US high school athletes, 2005-2006 through 2012-2013. Am J Sports Med. 43(1):26-33, 2015
                                              3. Klontzas ME et al: MR imaging of transient osteoporosis of the hip: an update on 155 hip joints. Eur J Radiol. 84(3):431-6, 2015
                                              4. Wagner D et al: Fragility fractures of the sacrum: how to identify and when to treat surgically? Eur J Trauma Emerg Surg. 41(4):349-62, 2015
                                              5. Yoder K et al: Risk factors associated with sacral stress fractures: a systematic review. J Man Manip Ther. 23(2):84-92, 2015
                                              6. Meredith DS et al: Incidence, diagnosis, and management of sacral fractures following multilevel spinal arthrodesis. Spine J. 13(11):1464-9, 2013
                                              7. Guerado E et al: Occult acetabular fracture in elderly patients. Open Orthop J. 6:582-6, 2012
                                              8. Liong SY et al: Lower extremity and pelvic stress fractures in athletes. Br J Radiol. 85(1016):1148-56, 2012
                                              9. Campbell SE et al: Imaging of stress injuries of the pelvis. Semin Musculoskelet Radiol. 12(1):62-71, 2008
                                              10. Zajick DC et al: Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 12(1):3-12, 2008
                                              11. Bencardino JT et al: Imaging of hip disorders in athletes. Radiol Clin North Am. 40(2):267-87, vi-vii, 2002
                                              12. Spitz DJ et al: Imaging of stress fractures in the athlete. Radiol Clin North Am. 40(2):313-31, 2002
                                              13. Otte MT et al: MR imaging of supra-acetabular insufficiency fractures. Skeletal Radiol. 26(5):279-83, 1997
                                              14. Hill PF et al: Stress fracture of the pubic ramus in female recruits. J Bone Joint Surg Br. 78(3):383-6, 1996
                                              15. Peh WC et al: Imaging of pelvic insufficiency fractures. Radiographics. 16(2):335-48, 1996
                                              16. Hayes CW et al: MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics. 13(5):1001-11; discussion 1012, 1993
                                              17. McBryde AM Jr: Stress fractures in athletes. J Sports Med. 3(5):212-7, 1975
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Fatigue fracture, overuse fracture, insufficiency fracture, fragility fracture
                                                        • Definitions

                                                          • Fatigue fracture: repetitive overuse trauma results in failure of normal bone
                                                          • Insufficiency fracture: normal activity results in failure of weakened (usually osteoporotic) bone
                                                            • Also called fragility fracture

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Nuclear Medicine Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      • Image Interpretation Pearls

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Matcuk GR Jr et al: Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol. 23(4):365-75, 2016
                                                                                          2. Changstrom BG et al: Epidemiology of stress fracture injuries among US high school athletes, 2005-2006 through 2012-2013. Am J Sports Med. 43(1):26-33, 2015
                                                                                          3. Klontzas ME et al: MR imaging of transient osteoporosis of the hip: an update on 155 hip joints. Eur J Radiol. 84(3):431-6, 2015
                                                                                          4. Wagner D et al: Fragility fractures of the sacrum: how to identify and when to treat surgically? Eur J Trauma Emerg Surg. 41(4):349-62, 2015
                                                                                          5. Yoder K et al: Risk factors associated with sacral stress fractures: a systematic review. J Man Manip Ther. 23(2):84-92, 2015
                                                                                          6. Meredith DS et al: Incidence, diagnosis, and management of sacral fractures following multilevel spinal arthrodesis. Spine J. 13(11):1464-9, 2013
                                                                                          7. Guerado E et al: Occult acetabular fracture in elderly patients. Open Orthop J. 6:582-6, 2012
                                                                                          8. Liong SY et al: Lower extremity and pelvic stress fractures in athletes. Br J Radiol. 85(1016):1148-56, 2012
                                                                                          9. Campbell SE et al: Imaging of stress injuries of the pelvis. Semin Musculoskelet Radiol. 12(1):62-71, 2008
                                                                                          10. Zajick DC et al: Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 12(1):3-12, 2008
                                                                                          11. Bencardino JT et al: Imaging of hip disorders in athletes. Radiol Clin North Am. 40(2):267-87, vi-vii, 2002
                                                                                          12. Spitz DJ et al: Imaging of stress fractures in the athlete. Radiol Clin North Am. 40(2):313-31, 2002
                                                                                          13. Otte MT et al: MR imaging of supra-acetabular insufficiency fractures. Skeletal Radiol. 26(5):279-83, 1997
                                                                                          14. Hill PF et al: Stress fracture of the pubic ramus in female recruits. J Bone Joint Surg Br. 78(3):383-6, 1996
                                                                                          15. Peh WC et al: Imaging of pelvic insufficiency fractures. Radiographics. 16(2):335-48, 1996
                                                                                          16. Hayes CW et al: MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics. 13(5):1001-11; discussion 1012, 1993
                                                                                          17. McBryde AM Jr: Stress fractures in athletes. J Sports Med. 3(5):212-7, 1975