INSUFFICIENCY FRACTURES OF THE ILIUM

Insufficiency fractures often occur in the sacrum and pubic rami but h ave rarely been reported in the ilium, where their frequency may be un derestimated, We studied a series of 14 patients with insufficiency fr actures of the ilium, Sh patients had an oblique fracture through the wing of the ilium (which was bilateral in one case) and nine a supraac etabular fracture, with in one case a superomedial extension into the iliac wing, The initial radiographs were normal, making the diagnosis difficult, A linear area of sclerosis along the fracture line was seen after a few weeks, The radionuclide examination provided early detect ion and often demonstrated multiple insufficiency fractures (mean 2.1 per patient), Computed tomography missed some of the fractures, wherea s magnetic resonance imaging proved a reliable diagnostic tool especia lly in patients;with supraacetabular fractures, showing the fracture a s a line of low signal surrounded by an area of edema whose contours w ere exactly the same as those of the hyperactive focus on the radionuc lide scan, Osteoporosis was a causative factor in all 14 patients and vitamin D deficiency in seven, Also, the patients had a history of flu oride therapy.