Pelvic Injury from Weight Machine

Abstract

HISTORY A 67yo osteoporotic female sustained a left pelvic injury while using a hip adductor weight machine at her gym. Patient was s/p right total hip replacement on April 21, 2003, and had been transitioned from outpatient physical therapy to outpatient gym acitivities during October 2003. At the gym, she developed acute onset of excruciating pain in her left hip. No lower extremity numbness, tingling or muscle weakness. Initial xrays were negative; however, pain progressed with continued mild exercise. PHYSICAL EXAMINATION Full left hip external/internal range of motion without pain. No lower extremity numbness or tingling. Palpation over the pubic rami and left sacroiliac joint elicited moderate tenderness. Gait was antalgic with a left pelvic tilt. DIFFERENTIAL DIAGNOSIS Adductor Magnus strain Avulsion fracture of pelvis Pelvic fracture TEST AND RESULTS Initial xray of pelvis: negative for fracture Bone scan: increased uptake at insertion of adductor magnus on pubic ramus Bone mineral density scan: Z-score −2.32 (i.e., osteoportic level) Blood work: CBC, ESR negative for any elevation Second xray of pelvis: fracture in superior and inferior rami on the left side of pelvis FINAL/WORKING DIAGNOSIS Acute, yet stable, left superior and inferior pubic rami fractures TREATMENT AND OUTCOMES Weight-bearing as tolerated. Adequate pain control to increase function. Resume physical therapy for controlled mobility and appropriate lower extremity strengthening exercises. Straight cane in right upper extremity to off-load left pelvic muscles and bones.