Postpartal Atraumatic Sacral Fracture. A Case Report and Biomechanical Comments
Authors:
R. Druga 1; B. Drugová 2
Authors‘ workplace:
Anatomický ústav, 2. lékařská fakulta, Univerzita Karlova, Praha, vedoucí prof. MUDr. R. Druga, DrSc.
1; Radiodiagnostické oddělení Nemocnice Na Homolce, Praha, vedoucí prim. MUDr. L. Janoušková, CSc.
2
Published in:
Ceska Gynekol 2008; 73(3): 192-195
Overview
Objective:
A case report describing postpartal nontraumatic sacral fracture.
Design:
A case report and biomechanical commment.
Setting:
Institute of anatomy, 2nd Medical faculty, Charles University at Prague.
Summary:
Nontrauma - related stress fractures of the sacrum are rare complications of the pregnancy and postpartal period. We report a new case of nontrauma-related postpartal sacral fracture. A 36 – year – old woman after second delivery presented symptoms of left L 5 radiculopathy. MRI of the lumbar spine and pelvis demonstrated a vertical fracture through the left sacral wing, paralel to the left sacroiliac joint (type Denis I). Fracture was surrounded by prominent bone marrow oedema. Biomechanical factors contributing to the stress fractures of the pelvic girdle in pregnancy and post partum are discussed.
Key words:
nontrauma – related sacral fracture, postpartum, bone marrow edema, MRI of the pelvis.
Sources
1. Albertsen, A., Egund, N., Jurik, A. Fatigue fracture of the sacral bone associated with septic arthritis of the symphysis pubis. Skeletal Radiol, 1995, 24, p. 605–607.
2. Alonso–Burgos, A., Royo, P., Diaz, L. et al. Labor-related sacral and pubic fractures. A case report. J Bone Joint Surg Am, 2007, 89, p. 396–398.
3. Alsobrook, J., Simons, SM., Sacral stress fracture in a marathon runner. Curr Sports Med Rep, 2007, 6, p. 39–42.
4. Blake, SP., Connors, AM. Sacral insufficiency fracture. Br J Radiol, 2004, 77, p. 891–896.
5. Blanch, J., Pacifici, R., Chines, A. Pregnancy - associated osteoporosis : report of two cases with long - term bone density follow up. Br J Rheumatol, 1994, 33, p. 269–272.
6. Breuil, V., Brocq, VO., Euller–Ziegler, L. Insuffiency fracture of the sacrum revealing a pregnancy associated osteoporosis. First case report. Ann Rheum Dis, 1997, 56, p. 279–280.
7. Damen, L., Buyruk, HM., Guller-Uysal, F., et al. The prognostic value of asymmetric laxity of the sacroiliac joints in pregnancy - related pelvic pain. Spine, 2002, 27, p. 2820–2824.
8. Dasgupta, B., Shah, N., Brown, H., et al. Sacral insuficiency fractures : An unsuspected cause of low back pain. Br J Rheumatol, 1998, 37, p. 789–793.
9. Dohin, B., Parot, R., Belliard, H., et al. Transverse sacral fracture in children : a case report presenting with neurological injury and review of the literature. Chir Orthop Reparatrice Appar Mot, 2006, 92, p. 595–601.
10. Dussa CU., El Daief, SG., Sharma SD., et al. Atraumatic fracture of the sacrum in pregnancy. J Obstet Gynaecol, 2005, 25, p. 716–717.
11. Grimaud, A., Oddo, F., Thibaud I. Fracture du sacrum par insufisance osseuse chez une femme enceinte. J Radiol, 1997, 78, p. 511–512.
12.. Hossain, M., Nokes, LD. A model of dynamic sacro-iliac joint instability from malrecruiment of gluteus maximus and biceps femoris muscles resulting in low back pain. Med Hypotheses, 2005, 65, p. 278–281,
13. Klossner, D. Sacral stress fracture in a female collegiate distance runner : a case report. J Athletic Training, 2000, 35, p. 453–457,
14. Larsen, E., Wilken–Jansen, C., Hansen, A. et al. Symptom giving pelvic girdle relaxation in pregnancy. I. prevalence and risk factors. Acta Obstet Gynecol Scand, 1999, 78, p. 105–110.
15. Leroux, JL., Denat, B., Thomas, E., Blotman, F., et al. Sacral insufficiency fractures presenting as acute low-back pain. Biomechanical aspects. Spine, 1993, 18, p. 2502–2506.
16. Miller, C., Major, N., Toth, A. Pelvic stress injuries in the athlete : managment and prevention. Sports Med, 2003, 33, p.1003–1012.
17. Narvaez, J., Narvaez, JA. Post-partal sacral fatigue fracture. Rheumatology, 2003, 42, p. 384–385.
18. Peh, WCG. Intrafracture fluid : a new diagnostic sign of insufficiency fractures of the sacrum and ilium. Br J Radiol, 2000, 73, p. 895–898.
19. Quan RF., Yang, DS., Wang, YJ. Study of the morphology and biomechanics of sacral fracture. Chin. J Traumatol., 2006, 9, p. 259–265.
20. Richardson, CA., Snijders, CJ., Hides, JA. et al. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine, 2002, .27, p. 399–405.
21. RousiŹre, M., Kahan, A., Job–Deslandre, Ch. Postpartal sacral fracture without osteoporosis. Joint Bone Spine, 2001, 68, p. 71–73.
22. Schmid, L., Pfirrman, C., Hess, T., et al. Bilateral fracture of the sacrum associated with pregnancy : A case report. Osteopor Int, 1999, 10, p. 91–93.
23. Silva, RT., De Bortoli, A., Laurino, CF., et al. Sacral stress fracture : an unusual cause of low back pain in an amateur tennis player. Br J Sports Med, 2006, 40, p. 460–461.
24. Thienpont, E., Simon, JP., Fabry G. Sacral stress fracture during pregnancy – a case report. Acta Ortho. Scand, 1999, 70, p. 517–526.
25. Wang, M., Dumas, GA. Mechanical behavior of the female sactoiliac joint and influence of the anterior and posterior sacroiliac ligament under sagital loads. Clin Biomech, 1998, 13, p. 293–299.
26. Zaman, FM., Frey, M., Slipman, CW. Sacral stress fractures. Curr Sports Med. Rep, 2006, 5, p. 37–43.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
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