Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Stress Fracture of the Pelvis

SYMPTOMS

There is gradual onset of diffuse or localised exercise-induced pain in the groin or pelvic area in a young anorexic athlete (often a female long-distance runner) or in elderly athletes with osteoporosis.

AETIOLOGY

Stress reaction from excessive jumping or running exercises in fragile athletes. Stress fractures in the flat bones such as the pelvis are typical in osteoporotic or osteopenic patients.

CLINICAL FINDINGS

Tenderness on palpation over affected bone. Eccentric jumping and running on hard surfaces aggravates the symptoms.

INVESTIGATIONS

X-ray may be false-normal until callus formation, which in osteoporotic athletes may take a long time. MRI will show localised bone oedema.

TREATMENT

This injury always responds to conservative treatment including modification of training until the fracture is healed.

REFERRALS

If the athlete shows signs of anorexia or osteoporosis, bone density tests a referral to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic specialist should be made; the fracture reflects a multi-factorial disease. If this is a one-off injury, caused by sudden increase in training, refer to a Dr Kevin Yip for planning of a three months’ return programme back to full sport.

EXERCISE PRESCRIPTION

Cycling and water exercises are good alternatives to keep up general fitness. If osteoporosis or anorexia is causing the injury, specialist treatment is required and training must be substantially modified.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs and X-ray.

DIFFERENTIAL DIAGNOSES

It is important to be aware that these symptoms can be caused by myriad different conditions. Bone tumours and intra-pelvic ailments must be excluded.

PROGNOSIS

Excellent-Good but the duration of symptoms may be very long. If anorexia is the cause, the prognosis is usually poor from a sporting point of view and the athlete should be told to abandon any attempts to reach elite level until the condition has improved.

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