Insufficiency Fracture of the Sacrum with Displacement and Neurologic Damage: a Case Report and Review of the Literature

Jones, John W.

doi:10.1111/j.1532-5415.1991.tb01652.x

Cited by 20 publications

(10 citation statements)

References 14 publications

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“…An increase in erythrocyte sedimentation rate and cerebrospinal fluid protein suggested an inflammatory or post-inflammatory process, but was presumably caused by mechanical effects on the nerve roots. Similar cases with neurological deficits as prominent complaints have been published [7,24].…”

Section: Discussionsupporting

confidence: 62%

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Vacuum phenomena in insufficiency fractures of the sacrum

et al. 1995

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The vacuum phenomenon may be an incidental finding in osteoarthritis of the sacro-iliac joint, but it has not been previously recognized in IFS. The presence of intra-articular vacuum phenomena in the sacro-iliac joints in combination with a sacral fracture and vacuum phenomena located within the sacral fracture supports a diagnosis of insufficiency fracture or may indeed be the clue by which this diagnosis is established.

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Section: Discussionsupporting

confidence: 62%

“…l). Insufficiency fractures of the sacrum can lead to neurological symptoms [7,24]. Two of our patients developed severe neurological symptoms over a period of 2 and 5 weeks respectively.…”

Section: Discussionmentioning

confidence: 98%

Vacuum phenomena in insufficiency fractures of the sacrum

et al. 1995

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“…Truncated sciatica and sciatica of S1 topography may be observed. Furthermore, neurological complications such as motor deficit of the lower limbs and urinary incontinence have been rarely reported 2223…”

Section: Discussionmentioning

confidence: 99%

Trans-iliac-sacral-iliac-bar procedure to treat insufficiency fractures of the sacrum

Vanderschot¹,

Küppers²,

Sermon³

et al. 2009

Indian J Orthop

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Background:Osteoporosis is an increasing problem attributed to the greater longevity of the population and the incidence of fractures related to osteoporosis. The presence of osteoporotic bone, comorbidities, and functional status of the patient require adequate solutions to improve the clinical outcome of sacral insufficiency fractures. Conservative treatment by means of prolonged bed rest and analgesics are associated with increased risks and complications. A sacroplasty significantly improves the functional outcome. We describe the trans-iliac-sacral-iliac-bar (TISIB) procedure and our clinical experience to treat insufficiency fractures of the sacrum.Materials and Methods:The records of 19 consecutive patients with a mean age of 71.7 years (range: 57-82 years) who had been managed with a TISIB procedure from 2005 till 2007 were reviewed retrospectively. There were 15 females and 4 males. Predisposing factors for sacral insufficiency fractures were osteoporosis (n = 12, 63%), radiotherapy (n = 6, 32%), and rheumatoid arthritis (n =1). Diagnosis with a mean delay of 3.7 months was mainly made by CT. All patients were preoperatively and at follow-up assessed by means of the visual analogue score (VAS), analgesic consumption, and the ability to perform activities of daily living (ADLs) using a 5-point pain scale: 1, without pain; 2, mild pain; 3, moderate pain; 4, severe pain and, 5 unable to perform ADLs because of pain.Results:The average duration of postoperative follow-up was 9 months (range: 3–24.5 months). No neurological complications occurred during the surgery. A postoperative radiographic study showed a well-positioned bar in every case. The mean VAS improved 44.7 mm (preoperative: 67.8; at follow-up: 23.2). Fifteen patients (79%) consumed narcotic analgesics before surgery, and only one (5%) at follow-up; two patients (10%) consumed NSAIDS before surgery and three (15%) after. Two patients (10%) consumed minor analgesics before, and 11 (58%) after the procedure. Finally, four patients (21%) were not taking any analgesics at follow-up. Before surgery, 9 patients (47%) were able to perform ADLs with a pain score of 4; 6 (32%) with a score of 3, and 4 (21%) a score of 2. At follow-up 1 (5%) did have a score of 4; 1 (5%) a score of 3, 8 (42%) a score of 2 and 9 (47%) a pain score of 1.Conclusion:A TISIB procedure relies on the principles of fracture treatment: fracture stabilisation and compression. The incapacitating problem of an insufficiency fracture of the sacrum can be elegantly solved by means of this minimally invasive procedure. A near-immediate improvement is noticed when looking at the VAS score, analgesics consumption, and the ability to perform ADLs.

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“…Symptoms are typically exacerbated by weight bearing and activity and relieved by rest. 24 Associated radicular pain may also be present.…”

Section: Discussionmentioning

confidence: 99%

“…Neurological examination, including straight leg raise, is typically normal. 24,25 Laboratory studies are usually within normal limits except for a mildly elevated alkaline phosphatase. 26 Differential diagnosis of SIF includes degenerative lumbar spine disease, vertebral body compression fractures, spinal stenosis, and neo-plasms.…”

Section: Discussionmentioning

confidence: 99%

Sacral Insufficiency Fractures: A Report of Two Cases and a Review of the Literature

Lin

Lachmann

Nagler

2001

Journal of Women's Health & Gender-Based Medicine

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Sacral insufficiency fractures (SIF) are a type of stress fracture that occur primarily in postmenopausal women. They were first described in 1982 by Lourie and have since been frequently overlooked as a cause of low back, buttock, or groin pain. We present two cases of SIF to demonstrate the clinical presentation, diagnosis, and treatment of patients with SIF. Both patients were elderly women with complaints of pelvic and low back pain in the absence of significant trauma. Physical examination was significant for marked sacral tenderness. Diagnostic imaging supported the diagnosis of SIF. Both patients underwent early rehabilitation, including early ambulation, and had good functional outcomes. These patients serve to illustrate how conservative treatment yields excellent clinical results in the majority of patients, with most reporting improvement within 1-2 weeks after fracture and complete resolution of symptoms after 6-12 months of treatment.

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Insufficiency Fracture of the Sacrum with Displacement and Neurologic Damage: a Case Report and Review of the Literature

Cited by 20 publications

References 14 publications

Vacuum phenomena in insufficiency fractures of the sacrum

Vacuum phenomena in insufficiency fractures of the sacrum

Trans-iliac-sacral-iliac-bar procedure to treat insufficiency fractures of the sacrum

Sacral Insufficiency Fractures: A Report of Two Cases and a Review of the Literature

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