pelvic insufficiency fracture
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Etiology
- minimal trauma in a patient with osteoporosis
Epidemiology
most common in elderly women
Pathology
- incomplete, non-displaced fracture of the pelvis
- may occur in sacrum, coccyx, pubic rami, or acetabulum
Clinical manifestations
- pain in buttocks & hips after minor trauma (fall)
- peristent pain (> 1 week) with inability to bear weight
- tenderness in buttocks region
- range of motion in hips is not affected
Radiology
- fracture is frequently not visible on initial radiograph
- bone scan may detect fracture (> 1 week after initial injury)
Management
- analgesia
- weight-bearing as tolerated, using cane or walker
- foam rings or pads can be helpful if there is pain on sitting
- prophylaxis for DVT if inactivity is likely to persist for weeks
- nasal calcitonin 100 units QD (analgesic effects)
- treat osteoporosis