Atypical findings of pelvic insufficiency fractures involving the iliac wing demonstrated by bone scintigraphy

Pelvic insufficiency fractures almost always occur in elderly women with osteoporosis. The typical sites are the sacrum and the pubis, with the ilium being less commonly affected. A 76-year-old woman was admitted for evaluation of pain around her right pelvis. Bone scintigraphy demonstrated multiple insufficiency fractures in the pelvis including the body and both alae of the sacrum, both iliac wings, and the right body of the pubis adjacent to the symphysis (parasymphyseal). The sacral and iliac insufficiency fractures on plain radiography had been overlooked entirely until a retrospective review had been carried out. Insufficiency fractures in the spine and ribs were also demonstrated.