Abstract
The aim of this study was to describe the MRI findings and clinical observations in a fatigue stress fracture of the sacrum. In this retrospective study, 380 conscripts (53 women, 327 men; age range 18–29 years, mean age 20.7 years) who suffered from stress-related hip pain were studied with MRI of the pelvis. The findings of MRI were evaluated with regard to stress fracture of the sacrum. Thirty-one (8%) patients had MRI changes in signal intensity of the cranial part of the sacrum, extending to the first and second sacral foramina. The MRI changes in signal intensity were intermediate on T1-weighted images, and high on short tau inversion recovery or T2-weighted fat-suppressed images. A linear signal void fracture line was also seen. Multiple stress injuries to the pelvic bones were also seen in 7 of 31 (23%) patients. Five patients (16%) had bilateral sacral stress fracture. Fatigue sacral stress fractures appeared more commonly in women than in men (p<0.001). During recovery time 20 of the 31 patients underwent control MRI, and fatty marrow conversion was seen in 8 (40%) cases as high signal intensity on T1-weighted images, which disappeared 5–6 months after the onset of symptoms. Fatigue sacral stress fractures are associated with stress-related hip pain. These fractures were more common in women than in men. Other stress injuries of the pelvis may be seen simultaneously with sacral stress fractures. Signal intensity of the sacrum was normal after 5–6 months.
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Peh WC, Khong PL, Ho WY, Yeung HW, Luk KD (1995) Sacral insufficiency fractures: spectrum of radiological features. Clin Imaging 19:92–101
Parikh VA, Edlund JW (1998) Sacral insufficiency fractures: rare complication of pelvic radiation for rectal carcinoma: report of a case. Dis Colon Rectum 41:254–257
Major NM, Helms CA (2000) Sacral stress fractures in long-distance runners. Am J Roentgenol 174:727–729
Eller DJ, Katz DS, Bergman AG, Fredericson M, Beaulieu CF (1997) Sacral stress fractures in long-distance runners. Clin J Sports Med 7:222–225
Czarnecki DJ, Till EW, Minikel JL (1988) Unique sacral stress fracture in a runner. Am J Roentgenol 151:1255
Bottomley MB (1990) Sacral stress fracture in a runner. Br J Sports Med 24:243–244
Volpin G, Milgrom C, Goldsher D, Stein H (1989) Stress fractures of the sacrum following strenuous activity. Clin Orthop:184–188
Lam KS, Moulton A (2001) Stress fracture of the sacrum in a child. Ann Rheum Dis 60:87–88
West SG, Troutner JL, Baker MR, Place HM (1994) Sacral insufficiency fractures in rheumatoid arthritis. Spine 19:2117–2121
Weber M, Hasler P, Gerber H (1993) Insufficiency fractures of the sacrum: twenty cases and review of the literature. Spine 18:2507–2512
Grier D, Wardell S, Sarwark J, Poznanski AK (1993) Fatigue fractures of the sacrum in children: two case reports and a review of the literature. Skeletal Radiol 22:515–518
Martin J, Brandser EA, Shin MJ, Buckwalter JA (1995) Fatigue fracture of the sacrum in a child. Can Assoc Radiol J 46:468–470
Thienpont E, Simon JP, Fabry G (1999) Sacral stress fracture during pregnancy: a case report. Acta Orthop Scand 70:525–526
Johnson AW, Weiss CB Jr, Stento K, Wheeler DL (2001) Stress fractures of the sacrum: an atypical cause of low back pain in the female athlete. Am J Sports Med 29:498–508
Milgrom C, Giladi M, Stein M et al. (1985) Stress fractures in military recruits: a prospective study showing an unusually high incidence. J Bone Joint Surg (Br) 67:732–735
Brahme SK, Cervilla V, Vint V, Cooper K, Kortman K, Resnick D (1990) Magnetic resonance appearance of sacral insufficiency fractures. Skeletal Radiol 19:489–493
Yao L, Johnson C, Gentili A, Lee JK, Seeger LL (1998) Stress injuries of bone: analysis of MR imaging staging criteria. Acad Radiol 5:34–40
Daffner RH, Pavlov H (1992) Stress fractures: current concepts. Am J Roentgenol 159:245–252
Weishaupt D, Schweitzer ME (2002) MR imaging of the foot and ankle: patterns of bone marrow signal abnormalities. Eur Radiol 12:416–426
Featherstone T (1999) Magnetic resonance imaging in the diagnosis of sacral stress fracture. Br J Sports Med 33:276–277
Grangier C, Garcia J, Howarth NR, May M, Rossier P (1997) Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof. Skeletal Radiol 26:517–524
Peh WCG (2000) Intrafracture fluid: a new diagnostic sign of insufficiency fractures of the sacrum and ileum. Br J Radiol 73:895–898
Slocum KA, Gorman JD, Puckett ML, Jones SB (1997) Resolution of abnormal MR signal intensity in patients with stress fractures of the femoral neck. Am J Roentgenol 168:1295–1299
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Ahovuo, J.A., Kiuru, M.J. & Visuri, T. Fatigue stress fractures of the sacrum: diagnosis with MR imaging. Eur Radiol 14, 500–505 (2004). https://doi.org/10.1007/s00330-003-1989-2
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DOI: https://doi.org/10.1007/s00330-003-1989-2