Acetabular Stress Fracture In A 69 Year Old Recreational Runner

Abstract

HISTORY A 69 year-old female recreational runner who runs 3 miles a day presents to Sports Medicine clinic for left hip pain that radiates to the groin and has been progressively worsening for three weeks. She also attends a high-impact aerobics class three times per week. She has a previous history of sciatica but describes this pain as markedly different. She also describes left lower quadrant abdominal pain but has no GI symptoms. She denies fevers, chills, or other systemic symptoms of recent illness. PHYSICAL EXAM This is a well developed well nourished 69 year old who appears younger than the stated age. Examination of the hip reveals equal limb lengths, no tenderness to palpation of bony prominances of the hip, although there is tenderness to internal and external rotation of the hip. Pain to hip flexion and adduction against resistance but no pain to hip extension or abduction. Range of motion is bilaterally symmetric and equal. No catching or clicking with examination. Negative piriformis stretch test. She has severe inguinal tenderness. Negative straight leg raise. Negative FABER exam. Normal skin. She is neurovascularly intact. She has good lower extremity strength. Her gait is normal. Abdomen-benign, no bruits. DIFFERENTIAL DIAGNOSIS Hip flexor strain Osteoarthritis Stress fracture of the hip Acute fracture of the hip Avascular necrosis of the hip Transient osteoporosis of the hip Lumbar radiculopathy Gout/Pseudogout Tumor- TESTS AND RESULTS CBC: Hb-9.6 g/dL-stable for her IHT Hct: 27.9 % WBC 6.7*1000/cmm MCV 106.0. ((Secondary to hydrea) Platelets 592 *1000/cmm (stable for this patient) 24 hr urine studies for creat clearance- 102cc/minute, calcium clearance 202mg/24hrs Sed Rate-49 High CRP-2.02 High CPK 16 Normal CMP Normal Uric Acid-normal Colonoscopy- normal 2001, 2004 Imaging- Plain film 2 views femur-normal. Two views of hip-mild hip DJD, mild SI arthritis,-mild osteitis pubis 5 views L Spine-DJD L5-S1 otherwise normal MRI L SpineNo focal abnormalities of the lumbar spine. No disk extrusion or spinal stenosis Hip-Anterior acetabular stress fracture CT Scan Hip: Mild DJD posterior aspect of the hip CT Abdomen/pelvis-splenomegaly size of spleen larger than liver Dexa Scan-Mild Osteopenia-Femur/Hip T-score −1.1 Osteopenia-L Spine T-score −1.9 FINAL WORKING DIAGNOSIS Anterior Acetabular Stress Fracture Left Hip-No displacement by CT: TREATMENT Nonweight bearing crutch use for 4 weeks. Active ROM in all planes. No Tylenol/NSAID use to mask pain Fosamax for Osteopenia in addition to current use of estrogen, calcium and vitamin D Further treatment plan will be determined