Pelvic insufficiency fracture mimicking bone metastasis: A case report

With improved survival rates in patients receiving high-dose curative radiotherapy for pelvic malignancies, higher incidences of pelvic insufficiency fractures have been observed. Insufficiency fractures are caused by high-dose curative radiotherapy, and like pathological fractures caused by bone metastasis and other etiologies, present with similar symptoms of pain, reduced mobility, and loss of independence, thus presenting a diagnostic challenge. In this case report and literature review, we report the case of an eighty-year old male with a history of bladder carcinoma and lung metastases who presented with sudden pain in the hip and inability to bear weight. The patient was referred to the Rapid Response Radiotherapy Program for suspicion of pathological fracture. This was ruled out in favor of an insufficiency fracture, secondary to radiation treatment (~60 Gy) eight months prior. After successful management with minimally invasive cementoplasty, pain symptoms significantly decreased and ambulatory function was restored. This case report highlights the need to consider pelvic insufficiency fractures in the differential diagnosis of cancer patients presenting with sudden pelvic pain, especially in elderly patients who have previously received high-dose radiotherapy. A thorough review of the patient’s past medical history along with appropriate imaging can confirm the cause of the fracture and guide management accordingly.