Insufficiency Fractures at Unusual Sites: A Case Series

Insufficiency fractures (IFs) are a subtype of stress fractures commonly associated with osteoporosis and Vitamin D deficiency. These nontraumatic fractures often occur in the pelvis and spine, but the involvement of other unusual sites is also not very uncommon. Plain radiographs and magnetic resonance imaging scan are the most commonly used imaging modalities for the diagnosis of IF.

We are presenting a series of five cases of IFs at unusual sites, along with a detailed literature review on this individual. A 50-year-old male patient with chronic kidney disease presented with both femoral neck and right lesser trochanter IF which was managed with cannulated screws. A 53-year-old male patient on steroid presented with sternum IF. A 26-year-old male patient presented with Vitamin D deficiency and accessory navicular IF. A 60-year-old female on bisphosphonate therapy came with bilateral femoral shaft fracture. All these three patients were managed conservatively. Another 62-year-old male patient with rheumatoid arthritis presented with sacrum IF which was managed with cannulated screw fixation.

IFs are a subtype of stress fractures commonly associated with osteoporosis and Vitamin D deficiency. A good clinical examination along with proper radiological investigation facilitates early diagnosis of IF in the osteoporotic bone. An early diagnosis helps in deciding the definitive course of treatment and to obtain a good result. An undisplaced fracture can be managed nonoperatively by treating the underlying medical cause, but fractures at the risk of displacement or a displaced fracture may need operative treatment.