Sacral Stress Fractures

Abstract

Stress fractures result from skeletal failure resulting from submaximal repetitive forces over time. Sacral stress fractures may represent an underdiagnosed cause of low back and buttock pain. They occur primarily in two populations, young active persons and elderly osteoporotic women, usually corresponding to fatigue and insufficiency-type fractures, respectively. The clinical presentation of these fractures is similar, but the medical and rehabilitation management of these patient populations differs and is tailored to the specific underlying etiology. In both types of fractures, appropriate conservative measures generally result in good functional outcomes. This paper provides an overview of the anatomical considerations, risk factors, clinical presentations, diagnostic imaging findings, appropriate laboratory studies, medical management, and rehabilitation management of patients with sacral stress fractures.

CT Fluoroscopically Guided Percutaneous Placement of Transiliosacral Rod for Sacral Insufficiency Fracture: Case Report and Technique

“…4 The primary risk factor is postmenopausal osteoporosis followed most com- monly by pelvic irradiation, corticosteroid therapy, and rheumatoid arthritis. 10 Although often caused by relatively minor trauma, 5 resulting pain can be severe, leading to a bedridden state. Unfortunately, the management of such fractures can be difficult.…”

“…1 As a result, CT, bone scintigraphy, and MR imaging may be required for accurate assessments of anatomy and acuity of fractures. 11,12 From a traditional standpoint, treatment of sacral insufficiency fractures has included bed rest, pain medication, and treatment with calcium and vitamin D, bisphosphonates, and calcitonin for underlying osteoporosis, 5 followed by a return to normal activities over a period of months. 10,13 Patients with conservative management generally experience improvement of symptoms after 1 to 2 weeks of treatment, with most patients pain free 6 to 12 months with complete healing after 9 months.…”

“…Despite that patients generally note improvement of pain within weeks to months with such treatment, 5 prolonged bed rest in elderly patients can be associated with significant morbidity. 3 Moreover, the medical costs imparted by acute inpatient hospitalizations have been estimated to be comparable with those imparted by femoral neck fractures.…”

Sacroplasty in a cadaveric trial: comparison of CT and fluoroscopic guidance with and without balloon assistance

“…Risk factors are osteoporosis, osteopenia, rheumatoid arthritis, prolonged steroid administration, and other causes of secondary osteoporosis, radiation therapy, primary bone tumors, and metastatic disease, whereas postmenopausal osteoporosis represents the main cause among them [29,40]. SIFs are often overlooked due to lack of clinical suspicious and non-specific nature of symptoms [25].…”

“…Treatments for this fracture type are commonly conservative including bed rest, moderate weight-bearing exercise, analgesia, osteoporosis medication, which often lead to complete healing within 9 months [23,29]. However, physicians have to be aware of complications from immobility including DVT, pulmonary embolism, pneumonia, progressive osteopenia, lingering illness, and death [2,9,18].…”