Pelvis

Pelvic stress fractures are relatively uncommon, representing only 1% to 2% of all stress fractures [79,80]. Pelvic stress fractures in runners most often occur in the pubic rami. Pubic rami fractures are commonly near the symphysis pubis (Fig. 14).

Symptoms most commonly include groin, hip, buttock, or thigh pain [7984]. These fractures most commonly occur in long distance female runners [81-85]. Severe groin pain may make running impossible. Standing on the leg of the affected side may elicit the pain or be impossible. Deep palpation

Parasymphaseal Area Hip

Fig. 14. Axial T2 FSE FS. Bilateral parasymphaseal stress fractures. 34-year-old female marathon runner who resumed training for a marathon postpartum. There is bilateral parasymphaseal bone marrow edema and small fracture lines were evident in the parasymphaseal regions consistent with stress fractures (arrows).

Fig. 14. Axial T2 FSE FS. Bilateral parasymphaseal stress fractures. 34-year-old female marathon runner who resumed training for a marathon postpartum. There is bilateral parasymphaseal bone marrow edema and small fracture lines were evident in the parasymphaseal regions consistent with stress fractures (arrows).

of the pubic rami may elicit extreme tenderness and help differentiate an overlying soft-tissue etiology such as muscle strain [84]. Pubic rami fractures are often nondisplaced and may be difficult to appreciate on plain film radiographs.

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