Sacral fatigue fracture in an amateur soccer player

Abstract

Sacral fatigue fractures represent a frequently overlooked cause of low-back and buttock pain in athletes. A high index of clinical suspicion and MRI utilization can provide the accurate diagnosis. A 38-year-old male amateur, midfielder, soccer player presented to our department with aggravating right buttock pain during the previous month, following an increase in training intensity and frequency on an artificial turf field. A point of maximal tenderness was demonstrated over the area of the right sacroiliac joint. No radiographic abnormalities were observed. MRI of the pelvis revealed the presence of a stress fracture in the right sacral ala. The patient underwent conservative treatment and resumed playing soccer 12 weeks later, with no residual or recurrent clinical complaints. Apart from the recent change in training regimen, decreased shock absorption related to the physical properties of old generation artificial turf may have also been involved in this case.

Figure 1

The coronal T1-w (a), STIR (b) and fat-suppressed T2-w (c) MR images of the pelvis depict an area of bone marrow edema in the right sacral ala (arrowheads) surrounding a low signal intensity obliquely oriented vertical fracture line (arrow).