Stress Fracture of the Pubic Ramus in a Female Long Distance Runner: A Case Report

Abstract

Stress fractures are overuse injuries of the bone caused by continuous repetitive submaximal stress over time. They constitute 0.7-20% of all sports injuries and are mainly seen in tibia, metatarsal bones and fibula. Pelvic stress fractures are rare (1-2%) and mostly seen in female long distance runners. Common complaints are groin, hip and thigh pain increasing with weight bearing activities.
A 41 years old recreational female runner was admitted to the clinic with chronic groin pain lasting for about eight months. She was performing running training on hard surfaces at high intensity for a long time and firstly she was admitted to the Orthopaedic and Traumatology clinic with groin pain. MR images have shown non-displaced fracture of the right ischium. There has been no relief with medication and rest, then the athlete was admitted to another clinic. X-ray and bone scintigraphy confirmed fracture line at the right superior pubic ramus and right ischium. Blood analysis has revealed low level of 25-OH vitamin D (13 ng/ml). Vitamin D3 supplementation has been prescribed for three months, and then the athlete has started 1 km daily slow running trainings. Due to exacerbation of pain during running, athlete was admitted to our clinic. Physical examination revealed normal posture and range of motion, and there were no swelling, inflammation and neurological signs and symptoms. As pelvis MRI and CT images confirmed healing, and 25-OH vitamin D level returned to normal limits, the athlete has then started trainings. Training volume has been increased gradually. Full recovery was achieved at the end of the third month, as there were no complaints during daily activities and training.
Stress fractures of the pelvis should be included in the differential diagnosis of female distance runners who have prolonged groin pain increasing with exercise. Detailed medical history, physical examination, blood tests, and radiological images are keys to reach certain diagnosis. Treatment plan should include risk factor analysis and progressive training programs.

Cite this article as: Senisik S, Ergün M Stress fracture of the pubic ramus in a female long distance runner: A case report. Turk J Sports Med 2017;52:70-6.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.