Sacral insufficiency fracture
Citation, DOI, disclosures and article data
At the time the article was created Ayush Goel had no recorded disclosures.View Ayush Goel's current disclosures
At the time the article was last revised Yahya Baba had no recorded disclosures.View Yahya Baba's current disclosures
Sacral insufficiency fractures are a subtype of stress fractures, which are the result of normal stresses on abnormal bone, most frequently seen in the setting of osteoporosis. They fall under the broader group of pelvic insufficiency fractures.
Risk factors are those of osteoporosis as well as other abnormal bone conditions, including:
- osteoporosis: most common
- rheumatoid arthritis
- Paget disease
- osteomalacia: Milkman syndrome
- diabetes mellitus
Long-term bisphosphonate use has been associated with insufficiency fractures.
They are usually seen in elderly females who present with low back pain without any history of significant trauma.
They are most frequently seen in the setting of osteoporosis, although any process which weakens bone is a risk factor.
They may be normal, or a sclerotic line may be noted in the involved region(s).
May show a fracture line along with sclerosis that is parallel to the sacroiliac joint, although even CT imaging is less sensitive as compared to MRI and nuclear imaging.
Can depict bone marrow edema as early as 18 days after the development of symptoms.
Treatment and prognosis
Treatment options can be variable ranging from conservative management to sacroplasty 5.
- 1. Lee YJ, Bong HJ, Kim JT et-al. Sacral insufficiency fracture, usually overlooked cause of lumbosacral pain. J Korean Neurosurg Soc. 2008;44 (3): 166-9. doi:10.3340/jkns.2008.44.3.166 - Free text at pubmed - Pubmed citation
- 2. Longhino V, Bonora C, Sansone V. The management of sacral stress fractures: current concepts. Clin Cases Miner Bone Metab. 2012;8 (3): 19-23. Free text at pubmed - Pubmed citation
- 3. Lyders EM, Whitlow CT, Baker MD et-al. Imaging and treatment of sacral insufficiency fractures. AJNR Am J Neuroradiol. 2010;31 (2): 201-10. doi:10.3174/ajnr.A1666 - Pubmed citation
- 4. Fujii M, Abe K, Hayashi K, Kosuda S, Yano F, Watanabe S, Katagiri S, Ka WJ, Tominaga S. Honda sign and variants in patients suspected of having a sacral insufficiency fracture. (2005) Clinical nuclear medicine. 30 (3): 165-9. Pubmed
- 5. Carina L. Butler, Curtis A. Given, II, Steven J. Michel, Phillip A. Tibbs. Percutaneous Sacroplasty for the Treatment of Sacral Insufficiency Fractures. (2012) American Journal of Roentgenology. doi:10.2214/ajr.184.6.01841956