Bilateral acetabular stress fractures in a paraplegic patient

Advances in rehabilitation programs have enabled many paraplegic persons to take part in activities in which the risk of trauma and skeletal injuries is comparable to that in the general population. Stress or spontaneous fractures are known to occur mainly as a result of severe osteoporosis and uncontrollable motion following removal of leg braces. However, stress fractures due to repeated minor trauma or prolonged physical activity have not been previously observed in paraplegic persons. In this report, bilateral acetabular stress fractures are described in a young paraplegic man during the course of ambulation therapy. The pattern of ambulation in these patients, who attempt to walk with crutches while their legs are placed in braces, is one contributing factor to stress fracture. Because of the paucity of physical findings and absence of pain, these fractures may go unrecognized, which can lead to more serious complications.