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Review
. 2022 Sep 1;22(3):385-392.

Fatigue sacral fractures: A case series and literature review

Aikaterini Tsatsaragkou  1 , Konstantinos Vlasis  1 , Konstantinos Raptis  2 , Evaggelos Zafeiris  3 , Andriana Mari  4 , Kalliopi Alpantaki  5 , Christos Koutserimpas  2
Affiliations
Review

Fatigue sacral fractures: A case series and literature review

Aikaterini Tsatsaragkou et al. J Musculoskelet Neuronal Interact. .

Abstract

Objectives: Fatigue sacral fractures (FSFs) are rare and often misdiagnosed. This study presents a series of FSFs and a meticulous literature review.

Methods: The present is an 11-year (2010-2021) retrospective observational study. The characteristics of all adult patients with FSF, including demographics, fracture type, treatment, history of fatigue fracture and imaging were evaluated.

Results: Eight cases (6 females; 75%), suffering from 12 fractures (4 bilateral cases) with mean age=33.4 years were studied. Two patients (25%) had suffered another fatigue fracture in the past. Mean symptoms' duration prior diagnosis was 8.5 weeks, while mean symptoms' duration after diagnosis was 10.75. In most cases (7; 87.5%), MRI revealed the fracture. According to the Kaeding-Miller classification; five fractures (42%) were grade III, four (33%) IV and three (25%) II. All patients were treated conservatively, with rest and analgesics, while three received vitamin D and calcium. One patient, due to delayed union, was commenced on teriparatide.

Conclusions: FSFs are often misdiagnosed; therefore, they should be included in the differential diagnosis for chronic low back-or-hip pain in athletes. History of other fatigue injuries seems to be a predisposing factor. It is of paramount importance to obtain advanced imaging for identifying a FSF.

Keywords: Fatigue Fracture; Fatigue Fractures in Athletes; Sacral Fracture; Teriparatide; Vitamin D.

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Conflict of interest statement

The authors have no conflict of interest.

Figures

Figure 1
Figure 1
A. T1 weighted MRI axial views of a fatigue sacral fracture (case 1 in Table 1). B. STIR MRI coronal view of the same fracture (case 1 in table 1). Fracture is classified according to Kaeding Miller classification as grade III. C coronal CT view of bilateral sacral fractures of case 2 (Table 1), D axial CT view of the same fractures. Both fractures are classified as grade IV according to Kaeding Miller classification.
See this image and copyright information in PMC

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