Inferior Pubic Rami Stress Fracture in a High School Sprinter: A Case Report

Pubic rami stress fractures comprise 1%-2% of all stress fractures and are most often seen in military recruits and long-distance athletes; they are less commonly reported in short distance athletes. We present an atypical inferior pubic rami stress fracture in a high school sprinter and discuss the current treatment standards along with broad clinical implications of the case.

A 15-year-old female high school track athlete presented to the sports medicine clinic with right hip pain after she felt a pop around her posterior right hip while running a 100-m sprint approximately 4 weeks prior. The pain was associated with severe, nonradiating pain, and inability to run afterwards. She came with bilateral hip and pelvic X-rays from an outside facility that were reported as normal. However, the overread of the images by the sports medicine provider revealed a nondisplaced, subacute right inferior pubic rami stress fracture. The patient was instructed to refrain from running for 3 months. Repeat imaging at 2- and 3-months postinjury revealed progressive healing that clinically correlated with symptom improvement. She then entered a return-to-run program with physical therapy and had full return to sport without limitation at 5 months postinjury.

It is important that sports medicine and orthopedic providers take a holistic approach, considering a broad differential that may be contributing to a patient's presentation, even if the answer is a known fracture entity in a less frequently reported athletic subgroup.