Olgu Sunumu
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Bilateral sakroileiti taklit eden multiple yetmezlik kırığı

Yıl 2020, Cilt: 13 Sayı: 3, 817 - 821, 18.09.2020
https://doi.org/10.31362/patd.746054

Öz

Bu olgu sunumunun amacı, bilateral sakroileit ayırıcı tanısı için kliniğimize yönlendirilen yaşlı kadın hastada saptanan multiple yetmezlik kırığı gelişmiş olan olguyu sunmaktı. Yetmiş bir yaşında kadın hasta, bel ağrısı ve ayrıca her iki kalça ve kasık bölgesinde ağrı şikayeti ile polikliniğimize başvurdu. Hastanın kas-iskelet sistemi muayenesinde, bel fleksiyonu ve ekstansiyonu kısıtlı ve ayrıca bilateral kalça rotasyonları ağrılı idi. Bilateral Faber, Mennel ve sakroiliak kompresyon testleri pozitifdi. Hastanın laboratuvar incelemesinde 25-hidroksi-Dvit seviyesi 3 ng/ml ve parathormon seviyesi 70 pg/ml olarak saptandı. Fizik muayene ile uyumlu olarak pelvik radyografide sakroiliak eklemde bilateral subkondral skleroz, koksafemoral eklem aralığında daralma, symphisis pubiste düzensizlik saptandı. Sakroiliak manyetik rezonans görüntüleme, her iki sakroiliak eklemi oluşturan periartiküler yüzeylerde T1 ağırlıklı görüntülerde yaygın hipointens ve STIR görüntülerinde hiperintens sinyal değişikliği ve ayrıca T1 ağırlıklı görüntülerde kırık çizgileri saptandı. Sonrasında çekilen sakroiliak bilgisayarlı tomografide ise sakrumun ön yüzünde, bilateral iliak kemiklerde ve pubik ramusta multiple yetersizlik kırığı hatları saptandı. Hastaya vitamin D eksikliğine bağlı multiple yetmezlik kırığı tanısı konuldu. D vitamini replase edildi ve konservatif tedavisi planlandı. Sonuç olarak bel ağrısı ile başvuran ve görüntülemede sakroileiti taklit edebilen eklem değişiklikleri olan yaşlı hastalarda, ayırıcı tanıda yetmezlik kırıkları göz önünde bulundurulmalıdır.

Kaynakça

  • 1. Nishino T, Ochiai F, Yoshizawa T, Mishima H, Yamazaki M. Isolated distal fibular stress fracture after total hip arthroplasty in a patient with developmental dysplasia of the hip. Case Rep Orthop 2020;2020:4218719. https://doi.org/10.1155/2020/4218719
  • 2. Vaishya R, Agarwal AK, Banka PK, Vijay V, Vaish A. Insufficiency fractures at unusual sites: A case series. J Orthop Case Rep 2017;7:76‐79. https://doi.org/10.13107/jocr.2250-0685.862
  • 3. Fottner A, Baur-Melnyk A, Birkenmaier C, Jansson V, Dürr HR. Stress fractures presenting as tumours: A retrospective analysis of 22 cases. Int Orthop 2009;33:489‐492. https://doi.org/10.1007/s00264-007-0488-5
  • 4. Matar HE, Hassan K, Duckett SP. Insufficiency sacral fracture-dislocation mimicking suicidal jumper's fracture. BMJ Case Rep 2016;2016:bcr2016216587. http://dx.doi.org/10.1136/bcr-2016-216587
  • 5. Baldwin MJ, Tucker LJ. Sacral insufficiency fractures: A case of mistaken identity. Int Med Case Rep J 2014;7:93‐98. https://doi.org/10.2147/IMCRJ.S60133
  • 6. Wild A, Jaeger M, Haak H, Mehdian SH. Sacral insufficiency fracture, an unsuspected cause of low back pain in elderly women. Arch Orthop Trauma Surg 2002;122:58–60. https://doi.org/10.1007/s004020100333
  • 7. Sudhir G, Kalra K, Acharya S, Chahal R. Sacral Insufficiency Fractures mimicking lumbar spine pathology. Asian Spine J 2016;10:558‐564. https://doi.org/10.4184/asj.2016.10.3.558
  • 8. Vural M, Üstün I, İnci E, Bes C. Sacroiliitis and sacral insufficiency fracture: A rare coexistence. Turk J Phys Med Rehab 2019;65:84-86. https://doi.org/10.5606/tftrd.2019.1795
  • 9. Memetoğlu OG, Ozkan FU, Boy NS, Aktas I, Kulcu DG, Taraktas A. Sacroiliitis or insufficiency fracture?. Osteoporos Int. 2016;27(3):1265‐1268.
  • 10. Paker N, Tekdos D. Sacral ınsufficiency fracture: Case report. Turk J Phys Med Rehab 2006;52:129-131.
  • 11. Lee P, van der Wall H, Seibel MJ. Looking beyond low bone mineral density: multiple insufficiency fractures in a woman with post-menopausal osteoporosis on alendronate therapy. J Endocrinol Invest 2007;30:590‐597. https://doi.org/10.1007/BF03346353

Multiple insufficiency fractures mimicking bilateral sacroiliitis

Yıl 2020, Cilt: 13 Sayı: 3, 817 - 821, 18.09.2020
https://doi.org/10.31362/patd.746054

Öz

The aim of this case report was to represent a case with multiple insufficiency fractures detected in an elderly female patient who was referred to our clinic for the differential diagnosis of bilateral sacroiliitis. A 71-year-old female patient was admitted to our outpatient clinic with the complaint of low back pain and also pain in her both hips and groin. On assessment of her musculoskeletal system, she had limited range of motion for low back and also had bilateral painful hip rotations. Bilateral Faber, Mennel and sacroiliac compression tests were positive. In her laboratory examination, 25-hydroxy-Dvit level was 3 ng/ml and parathormone level was 70 pg/ml. In consistent with physical examination pelvic radiograph revealed bilateral subchondral sclerosis in the sacroiliac joint, narrowing in the coxafemoral joint space, irregularity in symphisis pubis. Sacroiliac magnetic resonance imaging showed diffuse hypointense signal on T1-weighted images and hyperintense signal change on STIR images in the periarticular surfaces of bilateral sacroiliac joints and also fracture lines were detected on T1-weighted images. Subsequently, multiple insufficiency fracture lines were detected on the anterior face of the sacrum, bilateral iliac bones and the pubic ramus on the sacroiliac computed tomography. The patient was diagnosed with multiple insufficiency fractures due to vitamin D deficiency. Vitamin D was replaced and conservative treatment was planned. In conclusion, insufficiency fractures should be considered in differential diagnosis in elderly patients who present with low back pain and who have joint changes that may mimic sacroiliitis in imaging.

Kaynakça

  • 1. Nishino T, Ochiai F, Yoshizawa T, Mishima H, Yamazaki M. Isolated distal fibular stress fracture after total hip arthroplasty in a patient with developmental dysplasia of the hip. Case Rep Orthop 2020;2020:4218719. https://doi.org/10.1155/2020/4218719
  • 2. Vaishya R, Agarwal AK, Banka PK, Vijay V, Vaish A. Insufficiency fractures at unusual sites: A case series. J Orthop Case Rep 2017;7:76‐79. https://doi.org/10.13107/jocr.2250-0685.862
  • 3. Fottner A, Baur-Melnyk A, Birkenmaier C, Jansson V, Dürr HR. Stress fractures presenting as tumours: A retrospective analysis of 22 cases. Int Orthop 2009;33:489‐492. https://doi.org/10.1007/s00264-007-0488-5
  • 4. Matar HE, Hassan K, Duckett SP. Insufficiency sacral fracture-dislocation mimicking suicidal jumper's fracture. BMJ Case Rep 2016;2016:bcr2016216587. http://dx.doi.org/10.1136/bcr-2016-216587
  • 5. Baldwin MJ, Tucker LJ. Sacral insufficiency fractures: A case of mistaken identity. Int Med Case Rep J 2014;7:93‐98. https://doi.org/10.2147/IMCRJ.S60133
  • 6. Wild A, Jaeger M, Haak H, Mehdian SH. Sacral insufficiency fracture, an unsuspected cause of low back pain in elderly women. Arch Orthop Trauma Surg 2002;122:58–60. https://doi.org/10.1007/s004020100333
  • 7. Sudhir G, Kalra K, Acharya S, Chahal R. Sacral Insufficiency Fractures mimicking lumbar spine pathology. Asian Spine J 2016;10:558‐564. https://doi.org/10.4184/asj.2016.10.3.558
  • 8. Vural M, Üstün I, İnci E, Bes C. Sacroiliitis and sacral insufficiency fracture: A rare coexistence. Turk J Phys Med Rehab 2019;65:84-86. https://doi.org/10.5606/tftrd.2019.1795
  • 9. Memetoğlu OG, Ozkan FU, Boy NS, Aktas I, Kulcu DG, Taraktas A. Sacroiliitis or insufficiency fracture?. Osteoporos Int. 2016;27(3):1265‐1268.
  • 10. Paker N, Tekdos D. Sacral ınsufficiency fracture: Case report. Turk J Phys Med Rehab 2006;52:129-131.
  • 11. Lee P, van der Wall H, Seibel MJ. Looking beyond low bone mineral density: multiple insufficiency fractures in a woman with post-menopausal osteoporosis on alendronate therapy. J Endocrinol Invest 2007;30:590‐597. https://doi.org/10.1007/BF03346353
Toplam 11 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Rehabilitasyon
Bölüm Olgu Sunumu
Yazarlar

Hakan Alkan 0000-0001-8461-9131

Ayşe Sarsan 0000-0002-6930-6441

Necmettin Yıldız 0000-0002-1947-4375

Saadet Öztekin Bu kişi benim 0000-0002-9237-782X

Yayımlanma Tarihi 18 Eylül 2020
Gönderilme Tarihi 1 Haziran 2020
Kabul Tarihi 17 Haziran 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 13 Sayı: 3

Kaynak Göster

AMA Alkan H, Sarsan A, Yıldız N, Öztekin S. Multiple insufficiency fractures mimicking bilateral sacroiliitis. Pam Tıp Derg. Eylül 2020;13(3):817-821. doi:10.31362/patd.746054
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