Sacral insufficiency fracture

Case contributed by Ian Bickle
Diagnosis almost certain

Presentation

Numbness over bum cheeks for the last 6 weeks. Has loss of sensation over inner thirds of bum cheeks bilaterally on examination, nil loss of perianal sensation, Nil urinary/fecal incontinence. Has normal power/tone/reflexes.

Patient Data

Age: 60 years
Gender: Female
mri

Diffuse high T2 signal on STIR bilaterally in the sacrum.  Horizontal fracture line through the mid sacrum at the S2/S3 level.

Normal ilia.

No disc prolapse.

Capacious central canal and exit foramina.  No nerve root impingement.

Case Discussion

Appearances in keeping with a sacral fracture.

In the context of no trauma, this is most likely an insufficiency fracture.

Recommend bone density work up including a DEXA scan.

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