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Fatigue fractures of the sacrum in children: two case reports and a review of the literature

Abstract

We present the clinical and radiological features of two children with fatigue fractures of the sacrum. Both patients were active, had no underlying bone disease and presented with insidious onset of low back pain. Plain radiography was non-contributory to the diagnosis. In both patients a focal area of increased activity was present in the lateral aspect of the sacrum on bone scintigraphy, which corresponded to linear medullary sclerosis in the sacral ala demonstrated by computed tomography. Magnetic resonance imaging in one patient revealed a linear signal void in the sacral ala on T1- and T2-weighted images. This was surrounded by diffuse low marrow signal on T1-weighted images, and increased marrow signal on T2-weighted images. Fatigue fractures of the sacrum should be considered in the differential diagnosis of low back pain in children. An awareness of their appearance on magnetic resonance imaging is important as this modality is increasingly utilised, particularly in children.

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References

  1. 1.

    Attwell EA, Jackson DW (1991) Stress fractures of the sacrum in runners; two case reports. Am J Sports Med 19:531

  2. 2.

    Bottomley MB (1990) Sacral stress fracture in a runner. Br J Sports Med 24:243

  3. 3.

    Cooper KL, Beabout JW, Swee RG (1985) Insufficiency fractures of the sacrum. Radiology 156:15

  4. 4.

    Czarnecki DJ, Till EW, Minkel JL (1988) Unique sacral stress fracture in a runner. Am J Roentgenol 151:1255 (letter)

  5. 5.

    Daphner RH (1978) Stress fractures; current concepts. Skeletal Radiol 2:221

  6. 6.

    Davis AM, Evans NS, Struthers GR (1988) Parasymphyseal and associated insufficiency fractures of the pelvis and sacrum. Br J Radiol 61:103

  7. 7.

    Day DL, Letourneau JG, Crass JR, Goldberg ME, Drake DG (1987) Musculoskeletal case of the day. Am J Roentgenol 148:1048

  8. 8.

    Dennis F, Davis S, Comfort T (1988) Sacral fractures; an important problem. Retrospective analysis of 236 cases. Clin Orthop 227:67

  9. 9.

    Devas MB (1963) Stress fractures in children. J Bone Joint Surg [Br] 45B:528

  10. 10.

    Haller J, Kindynis P, Resnick D, et al (1989) Fatigue fracture of the sacrum; a case report. J Can Assoc Radiol 40:277

  11. 11.

    Hoang T, Nguyen T, Dafner RH, Lupetin AR, Deeb ZL (1988) Case report 491. Skeletal Radiol 17:364

  12. 12.

    Horev G, Korenreich C, Ziv N, Grunebaum M (1990) The enigma of stress fractures in the paediatric age; clarification through the new imaging modalities. Paediatr Radiol 20:469

  13. 13.

    Kozlowski K, Azouz M, Hoff D (1991) Stress fractures of the fibula in the first decade of life. Report of eight cases. Paediatr Radiol 21:381

  14. 14.

    Lee JK, Yao Z (1988) Stress fractures; MR imaging. Radiology 169:217

  15. 15.

    Milgrom C, Chisin R, Giladi M, Stein M, Kashtan H, Margulies J, Atlan H (1985) Multiple stress fractures — a longitudinal study of a runner with 13 lesions. Clin Orthop 192:174

  16. 16.

    Stafford SA, Rosenthal DI, Gebhardt MC, Brady TJ, Scott JA (1986) MRI in stress fracture; case report. Am J Roentgenol 147:553

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Correspondence to A. K. Poznanski M.D..

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Grier, D., Wardell, S., Sarwark, J. et al. Fatigue fractures of the sacrum in children: two case reports and a review of the literature. Skeletal Radiol. 22, 515–518 (1993). https://doi.org/10.1007/BF00209099

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Key words

  • Fatigue fracture
  • Sacrum
  • Paediatrics
  • Magnetic resonance imaging