Squash is a moderate to high intensity sport that requires a certain level of fitness. When musculoskeletal injuries occur they commonly involve the lower limb and back[
5]. As a weight-bearing joint, the hip is fundamental to the participation of sports such as squash. It is important in running and jumping as well as the twisting and turning movements needed for racquet sports. During normal weight bearing the hip joint is subjected to substantial forces. This can increase three to five times body weight during the movements described [
6]. There are a wide variety of acute, sub acute and chronic injuries affecting the hip joint as well as the surrounding soft tissues. Establishing a correct diagnosis can, thus, be difficult [
1]. Injuries to the hip joint include acetabular labral tears [
7], which have been associated with sudden twisting or pivoting motions and may contribute to the progression of hip arthritis [
8]. Presentation can be acute, but more commonly present insidiously with persisting or escalating symptoms. Similarly a stress fracture of the femoral neck can present with a gradual deterioration of symptoms [
9] and if left untreated may progress to a displaced fracture with significant long-term morbidity. Stress fractures of the acetabulum are rare, but have been described in military endurance athletes and recruits [
10]. The classification and treatment of fractures involving the acetabulum are well described with management based largely on the work done by Letournel [
11]. Assessment of the continuity of the weight bearing dome of the acetabulum can be achieved by the measurement of the roof angles on plain radiographs [
12] or by CT scan [
2]. Patients are often involved in high-energy events such as road traffic accidents where other injuries frequently coexist. Those with metabolic or neoplasic conditions are more likely to sustain fractures from accidents where the transmission of energy through the hip joint is lower. To the author's knowledge acute isolated fracture of the acetabulum simply from playing squash has not been reported. This case suggests that the transmission of forces through the hip joint during a match is sufficient to cause acetabular fractures in certain individuals.
Bone mineral density is often quoted as a T score. A T score is the number of standard deviations below the mean of a fit premenopausal woman but does not take into account age, weight or ethnicity. The risk of sustaining a fracture increases by a factor of 2 to 3 per T unit [
4]. This individual had a bone mineral density within normal parameters and a history which makes the probability of a pre-existing stress fracture small. Despite this, however, it would seem that the transmission of forces through the hip joint during a match is sufficient to cause acetabular fractures in certain individuals.