Sacral fatigue fractures in children with sacral spina bifida occulta

Hama, Shingo; Takata, Yoichiro; Sakai, Toshinori; Higashino, Kousaku; Abe, Mitsunobu; Nagamachi, Akihiro; Sairyo, Koichi

doi:10.1097/bpb.0000000000000207

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…Sakai et al 29 reported a significantly higher incidence of lumbar spondylolysis among patients with SBO than among those without SBO (16.2% vs 5.0%, respectively). Hama et al 8 presented 2 cases of sacral fatigue fracture in 9-year-old patients with SBO at each affected level. Thus, the presence of SBO may increase the risk of fatigue fractures by altering the mechanical stress on the lumbar spine and sacrum.…”

Section: Discussionmentioning

confidence: 99%

“…We also investigated imaging findings such as laterality, Risser sign, presence of spina bifida occulta (SBO), and course of the fracture lines. The Kaeding-Miller classification system 8 for stress fractures (Table 1) was used to grade injury severity.…”

Section: Data Collectionmentioning

confidence: 99%

“…Some possibilities are considered. First, there may be similarities in the risk factors for sacral fatigue fractures and spondylolysis, such as the presence of hypoplasia of the posterior column of the spine including SBO 8,29 or certain physical characteristics (weakness of core muscle strength and tightness in the lower limbs). 15,23 Second, the presence of spondylolysis may contribute to a diminished posterior support component in the lumbar spine, increasing the occurrence of sacral fatigue fractures.…”

Section: Imaging Findingsmentioning

confidence: 99%

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Clinical Features and Therapeutic Process of Sacral Fatigue Fractures in Adolescents

Hiranaka,

Miyazaki,

Inoue

et al. 2024

Am J Sports Med

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Background: Sacral fatigue fractures are a rare injury but should be considered as a differential diagnosis for low back and buttock pain in young adults. Collective reports are limited, most of which have focused on long-distance runners. Purpose: To investigate the characteristics of sacral fatigue fractures in adolescents. Study Design: Case series; Level of evidence, 4. Methods: We analyzed patient background characteristics, physical examination and imaging findings, and treatment courses of those diagnosed with sacral fatigue fractures using magnetic resonance imaging. Results: Among 34 patients with sacral fatigue fractures, 15 and 19 were male and female patients, respectively, with an age range of 11 to 19 years (mean age, 15.0 years). Almost all patients were athletes, and 29 patients performed their sport ≥5 times a week. Long-distance runners were the most commonly affected, comprising 7 patients, and participants in other common sports such as baseball (6 patients), basketball (4 patients), and soccer (3 patients) were also affected. Physical examination revealed tension sign (Lasègue test) on the affected side in 6 patients and tight hamstrings in 24 patients. Imaging findings included 18 patients with right-side involvement, 12 with left-side involvement, and 4 with involvement on both sides. In 11 patients, spina bifida occulta was observed at S1 and 8 patients had a history of lumbar spondylolysis with 4 patients having concurrent sacral fatigue fractures. Physical therapy was performed concurrently with the cessation of exercise, and return to exercise was permitted if the pain had been relieved after 1 month. All patients returned to sports at a median of 48 days (range, 20-226 days) after symptom onset. However, 2 patients experienced recurrence (1 patient on the ipsilateral side and 1 patient on the contralateral side). Conclusion: Sacral stress fractures are not limited to long-distance runners in this population and can manifest as lower back pain or buttock pain in athletes participating in a variety of sports. Although the course of treatment was generally good, the possibility of recurrence must always be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Imaging Findingsmentioning

confidence: 99%

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Clinical Features and Therapeutic Process of Sacral Fatigue Fractures in Adolescents

Hiranaka,

Miyazaki,

Inoue

et al. 2024

Am J Sports Med

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“…Fatigue fractures of the sacrum sometimes occur in young athletes due to repetitive stress loads [30] but are reported to be rare in children [31][32][33]. The condition is typically accompanied with low back-pain [31][32][33] and Hama et al [31] suggest a possible association with spina bifida occulta. The girl in our study reported no regular weekly training activity and she had no clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

Whole body magnetic resonance imaging in healthy children and adolescents. Bone marrow appearances of the axial skeleton

Brandis¹,

Zadig²,

Avenarius³

et al. 2022

European Journal of Radiology

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Sacral Fatigue Fracture in a Military Recruit

Burgess

Johnston²,

Silverman³

2017

Clinical Nuclear Medicine

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A 19-year-old male military recruit presented with 3 weeks of persistent left hip and groin pain after abnormally twisting his hip during a hike. Initial radiographs were interpreted as negative. He subsequently underwent a bone scan which revealed linear left sacral uptake along or paralleling the sacroiliac joint. Differential diagnostic considerations included unilateral sacroiliitis and sacral fracture. SPECT/CT was performed which confirmed left sacral fatigue stress fracture. Transitional lumbosacral anatomy was evident on radiographs with pseudoarticulation of the transitional left S1 transverse process with the sacrum. We postulate this predisposed the recruit to sacral fracture.

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Sacral fatigue fractures in children with sacral spina bifida occulta

Cited by 6 publications

References 15 publications

Clinical Features and Therapeutic Process of Sacral Fatigue Fractures in Adolescents

Clinical Features and Therapeutic Process of Sacral Fatigue Fractures in Adolescents

Whole body magnetic resonance imaging in healthy children and adolescents. Bone marrow appearances of the axial skeleton

Sacral Fatigue Fracture in a Military Recruit

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