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Isolated supra-acetabular insufficiency fracture: a case report
Yu-Min Lin1, Kwok-Man Tong, Tu-Sheng Lee
1Department of Orthopedics, Taichung Veterans General Hospital, 160, Section 3, Chung-Kang Road, Taichung, Taiwan.
Summary
An extremely rare acetabular insufficiency fracture occurred in a postmenopausal woman with systemic lupus erythematosus (SLE). This corticosteroid-induced bone issue highlights the need to suspect hip fractures in osteopenic women with hip pain.
Area of Science:
- Orthopedics
- Rheumatology
- Radiology
Background:
- Acetabular fractures typically result from trauma.
- Insufficiency fractures, especially isolated supra-acetabular ones, are exceptionally rare.
- Systemic lupus erythematosus (SLE) and corticosteroid use can lead to osteopenia and bone insufficiency.
Observation:
- A 59-year-old postmenopausal woman with SLE presented with spontaneous hip pain.
- Plain roentgenograms showed faint medullary sclerosis over the acetabular roof.
- Magnetic resonance imaging (MRI) revealed characteristic fracture lines.
Findings:
- Diagnosis confirmed an isolated insufficiency fracture in the supra-acetabular region.
- The fracture was attributed to corticosteroid-induced bony insufficiency in the context of SLE.
- The fracture demonstrated irregular linear low signal intensity on various MRI sequences.
Implications:
- Conservative management led to fracture healing.
- This case underscores the importance of considering insufficiency fractures in osteopenic individuals presenting with hip pain.
- Early diagnosis via advanced imaging like MRI is crucial for appropriate management.