Presentation
Fall from own height
Patient Data
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There is a subtle, non-displaced, fracture involving the right sacral ala with disruption of the anterior cortex. The anterior cortex of the S2 vertebral body superiorly is buckled, best seen on the sagittal images. There is no extension to the sacroiliac joint or left sacral ala.
Diffuse decreased bone mineralization is noted.
Case Discussion
Insufficiency fractures occur when normal physiological stress is placed on abnormally weakened (e.g. osteoporotic) bone. Sacral insufficiency fractures typically involve the sacral ala, lateral to the sacral foramina and are vertically oriented, paralleling the sacroiliac joint. Associated abnormalities include vertebral compression fractures and other pelvic insufficiency fractures.
These fractures may be overlooked on imaging of the lumbar spine obtained for generalized back pain.
Case co-author: Rehana Jaffer, MD, FRCPC