Korean J Bone Metab.  2012 May;19(1):47-51. 10.11005/kjbm.2012.19.1.47.

Sequential Sacral Insufficiency Fracture After Unilateral Pubic Fractures: A Case Report

• Park KS
• Lee DH
• Peni I
• Yoon TR

• KMID: 1464235
• DOI: http://doi.org/10.11005/kjbm.2012.19.1.47

Abstract

Osteoporotic fractures of the pelvic ring are not uncommon and among them sacral insufficiency fractures (SIFs) are often overlooked in patients with buttock or low back pain following no or minimal trauma, which results in diagnostic delays. SIFs are often bilateral and are commonly associated with other fractures - most frequently with a pubic ramus fracture. However, it remains unclear which fracture (sacral or pubic ramus) occurs first, and the only report on the subject found that the fracture sequence is initiated by a sacral fracture. The authors describe a case of sequential bilateral SIFs in a 74-year old woman following superior and inferior pubic rami fractures on one side. In conclusion we suggested that SIFs can occur after pelvic ring injury in any side because biomechanical disruption of the pelvic ring can induce the sacral fracture in patients with severe osteoporosis.

Keyword

Osteoporosis; Ramus fracture; Sacral insufficiency fracture

MeSH Terms

Buttocks
Female
Fractures, Stress
Humans
Low Back Pain
Osteoporosis
Osteoporotic Fractures

Figure

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  Fig. 1 Axial computed tomography image of the pelvis taken after a slip down showing a right superior (A) and an inferior (B) rami fracture (white arrow) but no fracture line on the sacrum (C).

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  Fig. 2 (A) T1 weighted magnetic resonance imaging taken at the local hospital showing a low signal intensity lesion on the right sacral alar. (B) Anteroposterior radiograph of the pelvis showing right superior and inferior ramus callus formations and increased radiopaque on right sacral alar (white arrow). (C) Tc-99m bone scan showing increased uptakes at the right superior and inferior rami and right sacrum (white arrow). (D) Axial computed tomography image of the pelvis showing a right sacral fracture (white arrow). No fracture line was evident on the left sacrum.

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  Fig. 3 (A) Axial computed tomography (CT) image of the pelvis 2 months after the right sacral insufficiency fracture showing a new fracture line (white arrow). (B) Axial CT image of the pelvis 10 months after right sacral insufficiency fracture showing complete bone union of both sacral fractures.

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