Diagnosis of occult fractures of the ischiopubic rami

Abstract

Introduction: Recently, the diagnosis of occult frac- tures has been facilitated due to increased availability and utilization of MRI. Diagnosing a fracture of the ischiopubic rami from a proximal femoral fracture, in particular, is difficult using physical exam alone and can be facilitated by having access to an MRI. Here we report both physical exam findings and MRI findings that help in differentiating occult fractures of the iliopubic rami. Materials and Methods: From April 2010 to December 2012, we identified 30 pa- tients (5 male and 25 female; aged 43 - 93 years old). We recorded if a traumatic episode occurred, ambu- latory status at the initial visit (bed ridden, standing up with an aid, walking with an aid). We also re- corded if imaging was used in determining the final diagnosis (radiographs, MRI or CT). Results: Twenty- one patients had a fracture as a result of a traumatic episode. In the remaining 9 cases, no trauma oc- curred and therefore the fractures were insufficiency fractures. Ten patients were bed ridden at the initial visit, eight patients were able to stand only with a walking aid, and the remaining twelve patients were able to walk with an aid. Occasional radiographs were used to confirm the presence of a fracture in 4 cases, MRI in 11 cases, and CT scan in 15 cases. Dis- cussion and Conclusions: Occult fractures of the is- chiopubic rami can occur without trauma and it can be difficult to differentiate these fractures from occult proximal femoral fractures. In these cases, MRI is useful to definitively obtain a diagnosis. In cases of pacemaker, bullet implantation or artificial hip joints, CT or occasional radiographs are also useful to diag- nose occult fractures of the ischiopubic rami.