Fracture / Sacral Fracture
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Transcript of Fracture / Sacral Fracture
Sacral Insufficiency
Fractures
Pradeep Chockalingam
Snr 2 Physio
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Definition
First described by Dr. Lourie in 1982
Sacral insufficiency fracture is a type of
stress fracture characterized by severe
incapacitating hip, groin, pelvic, buttock and
low back pain. It occur when normal or
physiological stresses are placed on
weakened bone that has a low elastic
resistance. (Paker N & Tekdos D 2006)
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Anatomy and Classification
Anatomy Denis Classification
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Causes
Osteoporosis
Radiation to the
pelvis
Steroid use
Rheumatoid arthritis
Hyperparathyroidism
Pregnancy
Paget's disease
Hip joint replacement
Lumbosacral fusion
Anorexia nervosa
Liver diseases &
transplantation
Breastfeeding
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Signs & Symptoms
Severe pain around
Buttock
Low back
Sacroiliac
Hip
Groin
Pelvis
Tenderness around
Buttock
Low back
Groin
Sacroiliac joint
Restricted hip
movements
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Features
Spontaneous or low velocity trauma
Common in females with osteoporosis
Associated with 60% of pubic ramus fractures
Difficult to identify by normal X-ray
Neurological deficit very rare
Most of the fractures occur in zone-1
Mostly undiagnosed or misdiagnosed
Less than 50% return to baseline mobility
Length of stay unilateral: 2-4 weeks,
bilateral: 8-36 weeks
Blake SP & Connors AM 2004, Graham G et al. 1994, Paker N & Tekdos D 2006 & Schindler OS et al 2007
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Diagnostic imaging
a) No sign of # in normal
X-ray (early)
b) Sclerotic changes in
normal X-ray after
4 weeks
c) Bone scan shows
abnormal sign
d) CT shows # R ala
e) Bone scan in 8 months
f) CT shows # R iliac in 8
months
Blake SP & Connors AM 2004
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a b
c d
e f
Facts about Pubic Ramus #
25% suffered from dementia
Mean length of stay 9 to 25 days
All patients in this group needs some mobility aid at discharge
84% requires extra support at discharge
Less than one third return to their baseline mobility within 90 days
One year mortality rate is 27%
High superior pubic ramus # have poor prognosis compared to the Low superior pubic ramus #
Hill RMF et al 2001, Morris RO et al 2000, Steinitz D et al 2004.
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Management
Adequate rest
Pain control
Encourage walking with appropriate aid
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Any Changes to Current Practice ?
Feel for tenderness around sacroiliac joint
If pain level high or persist for longer than the
normal time scale, consider to rule-out sacral
insufficiency fracture
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Reference
Blake SP & Connors AM. Sacral insufficiency fracture:
Pictoral review. B.J.Radiology 2004;77: 891-96
Graham G et al. Sacral insufficiency fractures in the
elderly. J.Bone Joint Surg 1994; 76-B: 882-06
Hill RMF et al. Fracture of the pubic rami. J. B&J Sur
2001; 83-B: 1141-44
Morris RO et al. Closed prlvic fractures: characteristics
and outcomes in older patients admitted to medical
and geriatric wards. Postgrad Med J 2000; 76: 646-
650
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Reference
Paker N & Tekdos D. Sacral insufficiency fracture: A
case report. Turk.P.M.Rehab 2006;52: 129-31
Schindler OS et al. Sacral insufficency fractures.
J.Ortho.Sur 2007; 15(3):339-46
Steinitz D et al. All superior pubic ramus fractures are
not created equal. Can J Surg 2004; 47-6: 422-25
www.eorthopod.com/public/patient_education/9207/sa
cral_insufficiency_fractures.html (Date 07/03/2009)
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