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Pelvic insufficiency fracture simulating metastatic bone disease
Journal of Manipulative and Physiological Therapeutics
|September 1, 1994
Summary
Pelvic insufficiency fractures, often missed due to lack of trauma, can mimic metastatic bone disease. Early diagnosis and treatment are crucial to prevent complications and ensure fracture healing.
Area of Science:
- Orthopedics
- Radiology
- Geriatric Medicine
Background:
- Pelvic insufficiency fractures are rare and often present with vague symptoms, leading to diagnostic challenges.
- Mechanical low back pain can be an initial, misleading symptom, delaying appropriate investigation.
Observation:
- A 58-year-old female presented with low back pain unresponsive to chiropractic care.
- Bone scan indicated pelvic metastatic disease; CT revealed pubic fractures. Biopsy excluded malignancy.
Findings:
- The patient was diagnosed with insufficiency fractures secondary to osteoporosis.
- Treatment with physiotherapy, medication, and calcitonin led to fracture union and symptom improvement over ten months.
Implications:
- Delayed diagnosis of pelvic insufficiency fractures is common due to the absence of clear trauma history and ambiguous imaging findings.
- Mistaking these fractures for metastatic bone disease can lead to significant morbidity; prompt diagnosis and management are essential.