Sacral insufficiency fractures: an unsuspected cause of low back pain [clinical conference] |
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Authors: | Dasgupta B; Shah N; Brown H; Gordon TE; Tanqueray AB; Mellor JA |
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Institution: | Southend Health Care Trust, Prittlewell Chase, Westcliff-on-Sea, Essex. |
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Abstract: | We describe 10 cases of sacral fractures diagnosed within the rheumatology
department at Southend Hospital over the last 5 yr. All presented with
sudden-onset low back pain. The majority were elderly, frail, with chronic
inflammatory disease (six with rheumatoid arthritis, one with polymyalgia
rheumatica, one with vasculitis) and had received steroids. Diagnosis was
delayed by the inability of plain radiographs to show these fractures and
was ultimately demonstrated by technetium scintigraphy/computed tomography
scan. We feel that this diagnosis should be considered in elderly patients
with rheumatoid arthritis or other risk factors for osteoporosis who
present with low back pain and sacral tenderness. Further clues may be
parasymphyseal tenderness (suggesting associated pubic ramus fracture),
elevated alkaline phosphatase and plain radiograph showing pubic ramus
fractures or parasymphyseal sclerosis. Patients with this complication
generally have a poor prognosis and two of our patients have died. Seven
required in-patient stay (mean 20 days; range 14-41). The mortality,
morbidity and costs incurred in management may be comparable to those of
femoral neck fractures.
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