Korean J Radiol.  2005 Mar;6(1):47-51. 10.3348/kjr.2005.6.1.47.

Fatigue Stress Fractures of the Pubic Ramus in the Army: Imaging Features with Radiographic, Scintigraphic and MR Imaging Findings

• Lee SW
• Lee CH

• KMID: 1783174
• DOI: http://doi.org/10.3348/kjr.2005.6.1.47

Abstract

Although fatigue fractures are not unusual in athletes and military personnel those of the pubic ramus are rare. We report three cases of fatigue fractures of the inferior pubic rami in two male recruits and one female military cadet. On the initial radiograph, most of the lesions were subtle and easy to overlook. However, bone scintigraphy provided more distinct images that allowed easy and early detection of lesions, and MR imaging presented more diagnostic information, which allowed a precise diagnosis.

Keyword

Bones, radionuclide studies; Bones, MR; Fractures, stress; Pubic bones

MeSH Terms

Adult
Female
Fractures, Stress/*diagnosis/radiography/radionuclide imaging/surgery
Humans
Magnetic Resonance Imaging
Male
Military Personnel
Pubic Bone/*injuries

Figure

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  Fig. 1 Bilateral fatigue fractures of the inferior pubic rami in a 22-year-old male recruit.

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  Fig. 2 Bilateral fatigue fractures of the inferior pubic rami in a 20-year-old male recruit.

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  Fig. 3 A 19-year-old female military cadet with a fatigue fracture of the left inferior pubic ramus.

Reference

1. Kim SM, Park CH, Gartland JJ. Stress fracture of the pubic ramus in a swimmer. Clin Nucl Med. 1987. 12:118–119.

2. Thorne DA, Datz FL. Pelvic stress fracture in female runners. Clin Nucl Med. 1986. 11:828–829.

3. Kiuru MJ, Pihlajamaki HK, Ahovuo JA. Fatigue stress injuries of the pelvic bones and proximal femur: evaluation with MR imaging. Eur Radiol. 2003. 13:605–611.

4. Miller C, Major N, Toth A. Pelvic stress injuries in the athlete: management and prevention. Sports Med. 2003. 33:1003–1012.

5. Pavlov H, Nelson TL, Warren RF, Torg JS, Burstein AH. Stress fractures of the pubic ramus. A report of twelve cases. J Bone Joint Surg Am. 1982. 64:1020–1025.

6. Wilcox JR Jr, Moniot AL, Green JP. Bone scanning in the evaluation of exercise-related stress injuries. Radiology. 1977. 123:699–703.

7. Hill PF, Chatterji S, Chambers D, Keeling JD. Stress fracture of the pubic ramus in female recruits. J Bone Joint Surg Br. 1996. 78:383–386.

8. Meurman KO. Stress fracture of the pubic arch in military recruits. Br J Radiol. 1980. 53:521–524.

9. Ishibashi Y, Okamura Y, Otsuka H, Nishizawa K, Sasaki T, Toh S. Comparison of scintigraphy and magnetic resonance imaging for stress injuries of bone. Clin J Sport Med. 2002. 12:79–84.

10. Kiuru MJ, Pihlajamaki HK, Hietanen HJ, Ahovuo JA. MR imaging, bone scintigraphy, and radiography in bone stress injuries of the pelvis and the lower extremity. Acta Radiol. 2002. 43:207–212.