Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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November 23, 2009
Sacral Insufficiency Fracture
- Usually occur in osteoporotic bone with minimal or unremembered trauma; majority occur in elderly females and are frequently bilateral presenting as low back pain.
- Relatively under-diagnosed. MRI is substantially better than CT in detecting insufficiency fractures.
- Best diagnostic clue: bilateral or unilateral sacral marrow edema adjacent to sacroiliac joints on MRI; cortical break and sclerotic bands parallel to sacroiliac joints on CT and plain film; "H" shaped pattern of increased radiotracer uptake in sacrum on bone scintigraphy; concomitant insufficiency fractures seen in lumbar spine and pelvis.
- Top Differential Diagnoses: sacral metastases, sacral osteomyelitis, sacroiliitis. Differentiated from these conditions by absence of soft tissue masses, collections and lack of bony expansion.
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