In Fanconi syndrome, hypophosphatemic osteomalacia is caused by proximal renal tubule dysfunction which leads to impaired reabsorption of amino acids, glucose, urate, and phosphate. We present a rare case of a 43-year-old Korean male who was found to have insufficiency stress fracture of the femoral neck secondary to osteomalacia due to Fanconi syndrome. He had been receiving low-dose adefovir ...

Radiographically occult and subtle fractures are a diagnostic challenge. They may be divided into (1) "high energy trauma fracture," (2) "fatigue fracture" from cyclical and sustained mechanical stress, and (3) "insufficiency fracture" occurring in weakened bone (e.g., in osteoporosis and postradiotherapy). Independently of the cause, the initial radiographic examination can be negative either ...

Introduction The stress fracture of the femoral head rarely occurs; but, it is generally encountered in case of bone insufficiency, and it is exceptional in younger individuals. The main differential diagnosis may include several diseases, namely, slipped upper femoral epiphysis, septic arthritis, osteomyelitis, and Perthes' disease. Bone scintigraphy is very sensitive but lacks specificity. No...

Pelvic insufficiency fractures are fairly common in elderly patients and can be a source of major functional impairment, particularly when they involve the ilium. Early rehabilitation with adequate pain relief has been the traditional method of treatment. The recently developed S2 alar iliac technique involves placing pelvic fixation into the ilium through a pathway from the sacral ala. The bon...

We present a case report of a 45-year old man who sustained a central dislocation of the hip secondary to an insufficiency fracture of the acetabulum. At the time of presentation he was on alendronate therapy for osteoporosis which had been previously investigated. CT scanning of the pelvis was useful for pre-operative planning which confirmed collapse of the femoral head but no discontinuity o...

Initial diligent resuscitation of the multiply-injured patient, with early fixation of the major orthopaedic injuries, has significantly reduced the incidence of post-traumatic respiratory complications from the unacceptably high levels which were seen 20 years ago. With these improvements we may be entering an era in which the risk of these complications is independent of the orthopaedic injur...

We present the case of an insufficiency fracture of the femoral shaft in a 61-year-old man who had received bisphosphonate therapy to reduce the fracture risk from lytic renal cell carcinoma metastases to the spine. Approximately 1.5 years after beginning monthly intravenous infusions of zoledronic acid (Zometa), the patient complained of persistent thigh pain. Radionuclide bone scan showed mil...

A 79-year-old woman was seen due to low back pain and severe right hip pain. The pain was radiating to the right calf. The patient reported numbness of her right ankle and toes. On detailed questioning, she reported that her hip pain worsened with sitting and walking. She stated that her hip pain improved when lying supine. Her medical history revealed hypertension and osteomalacia, but no trau...

Atraumatic patellar fractures after Total Knee Arthroplasty (TKA) are rare in unresurfaced patella. Previous reports are few and have highlighted association of these fractures with rheumatoid arthritis and gout along with interference with patellar blood flow after lateral release and Hoffas’ fat pad excision. We report a case of insufficiency fracture of patella in a patient following TKA aft...

CONTEXT Serum 25-hydroxyvitamin D (25OHD) concentrations greater than 30 ng/ml have been recommended for lowering fracture risk. OBJECTIVE Our objective was to determine whether 25OHD sufficiency is a prerequisite for effective response to teriparatide (TPTD). DESIGN AND PATIENTS Data were from 1620 osteoporotic postmenopausal women in the Fracture Prevention Trial. The response to TPTD was...