Sacral insufficiency fractures

Case contributed by Bassem Marghany
Diagnosis almost certain


Low back pain and limping for 1 month following recent normal vaginal delivery

Patient Data

Age: 30 years
Gender: Female

Linear irregular sacral fracture sclerotic lines parallel to the sacroiliac joints with surrounding bone marrow edema exhibiting bright signals on STIR & T2 fat sat images.

Mild bilateral subarticular bone marrow edema is seen at the sacroiliac joints, more at the iliac side on the right, denoting active sacroiliitis.

Pelvic radiographs


X-rays show no fracture lines.

Case Discussion

Sacral insufficiency fractures are a subtype of stress fractures occurring when normal stresses are applied to abnormal bone.

The patient had severe vitamin D deficiency, anemia, and recent normal vaginal delivery.

X-rays may be normal (as in this case).  

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