fracture / sacral fracture

Sacral Insufficiency

Fractures

Pradeep Chockalingam

Snr 2 Physio

www.scribd.com/cpradheep

Definition

First described by Dr. Lourie in 1982

Sacral insufficiency fracture is a type of

stress fracture characterized by severe

incapacitating hip, groin, pelvic, buttock and

low back pain. It occur when normal or

physiological stresses are placed on

weakened bone that has a low elastic

resistance. (Paker N & Tekdos D 2006)


Anatomy and Classification

Anatomy Denis Classification

www.eorthopod.com/public/patient_education/9207/sacral_insufficiency_fractures.html


Causes

Osteoporosis

Radiation to the

pelvis

Steroid use

Rheumatoid arthritis

Hyperparathyroidism

Pregnancy

Paget's disease

Hip joint replacement

Lumbosacral fusion

Anorexia nervosa

Liver diseases &

transplantation

Breastfeeding


Signs & Symptoms

Severe pain around

Buttock

Low back

Sacroiliac

Hip

Groin

Pelvis

Tenderness around

Buttock

Low back

Groin

Sacroiliac joint

Restricted hip

movements


Features

Spontaneous or low velocity trauma

Common in females with osteoporosis

Associated with 60% of pubic ramus fractures

Difficult to identify by normal X-ray

Neurological deficit very rare

Most of the fractures occur in zone-1

Mostly undiagnosed or misdiagnosed

Less than 50% return to baseline mobility

Length of stay unilateral: 2-4 weeks,

bilateral: 8-36 weeks

Blake SP & Connors AM 2004, Graham G et al. 1994, Paker N & Tekdos D 2006 & Schindler OS et al 2007


Diagnostic imaging

a) No sign of # in normal

X-ray (early)

b) Sclerotic changes in

normal X-ray after

4 weeks

c) Bone scan shows

abnormal sign

d) CT shows # R ala

e) Bone scan in 8 months

f) CT shows # R iliac in 8

months

Blake SP & Connors AM 2004


a b

c d

e f

Facts about Pubic Ramus #

25% suffered from dementia

Mean length of stay 9 to 25 days

All patients in this group needs some mobility aid at discharge

84% requires extra support at discharge

Less than one third return to their baseline mobility within 90 days

One year mortality rate is 27%

High superior pubic ramus # have poor prognosis compared to the Low superior pubic ramus #

Hill RMF et al 2001, Morris RO et al 2000, Steinitz D et al 2004.


Management

Adequate rest

Pain control

Encourage walking with appropriate aid


Any Changes to Current Practice ?

Feel for tenderness around sacroiliac joint

If pain level high or persist for longer than the

normal time scale, consider to rule-out sacral

insufficiency fracture


Reference

Blake SP & Connors AM. Sacral insufficiency fracture:

Pictoral review. B.J.Radiology 2004;77: 891-96

Graham G et al. Sacral insufficiency fractures in the

elderly. J.Bone Joint Surg 1994; 76-B: 882-06

Hill RMF et al. Fracture of the pubic rami. J. B&J Sur

2001; 83-B: 1141-44

Morris RO et al. Closed prlvic fractures: characteristics

and outcomes in older patients admitted to medical

and geriatric wards. Postgrad Med J 2000; 76: 646-

650


Reference

Paker N & Tekdos D. Sacral insufficiency fracture: A

case report. Turk.P.M.Rehab 2006;52: 129-31

Schindler OS et al. Sacral insufficency fractures.

J.Ortho.Sur 2007; 15(3):339-46

Steinitz D et al. All superior pubic ramus fractures are

not created equal. Can J Surg 2004; 47-6: 422-25

www.eorthopod.com/public/patient_education/9207/sa

cral_insufficiency_fractures.html (Date 07/03/2009)


fracture / sacral fracture

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