Atraumatic Sacral Fracture in Late Pregnancy: A Case Report

Abstract

Study Design Case report. Objective Sacral fractures, traumatic or atraumatic, are a rather rare cause of low back pain. The majority of the cases of pregnancy-related sacral fractures are reported as a postpartum complication, and only few cases of sacral atraumatic fractures have been reported in the last trimester of the pregnancy. The aim of this study is to report a rare case of atraumatic sacral fracture in the third trimester of pregnancy. Methods We report the case of a 30-year-old Caucasian European woman during her 37th week (36 weeks and 4 days) of gestation, who complained during her scheduled obstetric examination of continuous low back pain with no associated history of trauma. The patient performed activities of daily living with a normal level of fatigue and reported no running or walking long distances. She was examined in our department, and a magnetic resonance imaging scan was performed that showed a vertical nondisplaced fracture in her left sacrum. Results The patient was treated conservatively, and analgesics were administrated according to the consensus of the orthopedic and the anesthesiology departments. No further complications were recognized in the remaining period of her pregnancy, and a healthy child was born by caesarean section. Conclusions Atraumatic fractures of the sacrum should be included in the differentiated diagnosis of pregnant patients with low back pain.

An Atraumatic Sacral Fracture with Lumbosacral Radiculopathy Complicating the Early Postpartum Period: A Case Report

“…Often, fatigue fractures will show surrounding marrow edema with formal radiographic evidence of the fracture only becoming apparent within 1 month of the onset of symptoms (Figure 1). We and others have shown that CT and x-rays lack the appropriate resolution to isolate such fractures and pose teratogenic risks to the fetus [7,11–13,16,17,20]. Exclusion of pregnancy associated osteoporosis is also required by means of formal bone densitometry and fasting metabolic biochemical assessments [7,15–17,20].…”

“…However, atraumatic stress fractures of the sacrum arising intrapartum or during the early postpartum are unusual and rare complications of pregnancy. To date, only a handful of cases having been reported across North America [5–7], Europe [8–13], the Middle East [14–19], and South Korea [20]. These fractures are classified as either insufficiency or fatigue fractures [21].…”

Sneezing: A Rare Cause of Sacral Insufficiency Fracture in a Young Osteoporotic Woman

“…Fatigue fractures occur in healthy bones under abnormal stresses, while the latter occurs in weakened bones under normal stresses. Sacral stress fractures are mostly seen in athletes, especially long-distance runners, due to unusual loads with repetitive activity [5]. Sacral fatigue fractures have been reported in athletes and during postpartum and intrapartum periods most of which were related to excessive weight gain, hyperlordosis, pelvic ligament weakness and osteopenia during pregnancy, whereas insufficiency fractures have been mostly reported in the elderly postmenopausal osteoporotic patients [5,6].…”

Imaging of Sacral Stress and Insufficiency Fractures

“…B. Läufer) und das weibliche Geschlecht Stressfrakturen vermuten [81,82]. Als differenzialdiagnostische Besonderheit sind schwangere Patientinnen zu erwähnen, die ebenfalls Stressfrakturen im Becken aufweisen können [18,83].…”