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sacral insufficiency fracture; osteoporotic sacral fracture

Etiology: - minimal trauma fracture due to osteoporosis Epidemiology: - older women Pathology: - frequently bilateral fractures Clinical manifestations: - low back pain & buttocks pain - aggravated by sitting or standing - relieved in supine position - pain on compression of the sacrum - no pain on movement of the lumbar spine - no neurologic signs or symptoms - straight leg raise tests are normal Radiology: - X-ray of the lumbosacral spine is generally unrevealing - CT of pelvis is the imaging of choice - displacement of the anterior border of the sacrum - scintigraphy often show 'H' or butterfly-shaped fractures Management: - prognosis - pain resolves in 4-6 weeks in most patients

General

sacral fracture minimal trauma (pathologic, osteoporotic, fragility, insufficiency) fracture

References

  1. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  2. Galbraith JG, Butler JS, Blake SP, Kelleher G. Sacral insufficiency fractures: an easily overlooked cause of back pain in the ED. Am J Emerg Med. 2011 Mar;29(3):359.e5-6. PMID: 20675092
  3. Schindler OS, Watura R, Cobby M. Sacral insufficiency fractures. J Orthop Surg (Hong Kong). 2007 Dec;15(3):339-46. PMID: 18162683
  4. Hatgis J, Granville M, Jacobson RE et al. Sacral insufficiency fractures: recognition and treatment in patients with concurrent lumbar vertebral compression fractures. Cureus. 2017;9(2):e1008 PMID: 28293486 PMCID: PMC5333948 Free PMC article https://www.cureus.com/articles/6245-sacral-insufficiency-fractures-recognition-and-treatment-in-patients-with-concurrent-lumbar-vertebral-compression-fractures