What's the most likely diagnosis?

• 78 year-old female with back pain

1. Metastases to sacrum
2. Sacral insufficiency fracture
3. Osteoid osteoma
4. Bladder cancer
5. Ankylosing spondylitis

Answer:

 

2. Sacral insufficiency fracture

 

 

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Sacral insufficiency fractures

General considerations

• Normal sacrum almost never sustains an isolated fracture
• They usually occur associated with other pelvic fracture and imply a force frequently sufficient to injure pelvic organs
• Insufficiency and fatigue fractures are subgroups of stress fractures
• Insufficiency fractures are fractures in abnormal bone (e.g. osteoporosis) which undergoes normal stress
• Fatigue fractures are fractures in normal bone which undergoes abnormal stress (e.g. March fractures)
• In the sacrum, such fractures occur in
  • Postmenopausal women with osteoporosis (more common after age 60)
  • Long-term corticosteroid use
  • Such as those with rheumatoid arthritis or collagen-vascular disease
  • Those who have undergone radiation therapy to the pelvis

 

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