Sacral Insufficiency Fracture Definition, Symptoms, Causes, Healing Time, Management

The sacrum is a bone that has the shape of a wedge and is a component of the pelvis. This structure transfers body weight to the pelvic girdle. Sacral insufficiency fractures develop when the sacrum's bone quality deteriorates to the point where it can no longer support the body's weight. As a result of this bone loss, the bone's supporting structure is compromised. Older women are more likely to suffer from sacral insufficiency fractures than younger women, as this condition is typically brought on by osteoporosis.

Definition

Sacral insufficiency fractures (SIFs) can be defined as the inability of sacrum bone to withstand the stress of weight bearing due to the deteriorating structure of bone. Sacral insufficiency fractures, also known as SIFs, are a subclass of stress fractures that occur when a normal load is given to a bone that has decreased flexibility. SIFs are typically more prevalent in elderly women and are linked to underlying metabolic bone diseases such as osteoporosis or Paget's disease.

Symptoms

It might be difficult to diagnose when the clinical presentation and physical examination are unpredictable. This illness, which is clinically indicated by discomfort in the inguinal and gluteal regions, frequently affects individuals who have either no trauma or relatively minor trauma as a result of a fall. The symptoms do follow the typical stress pattern of getting worse with exertion and better with rest. 

Symptoms may include intense pain in the buttocks, back, hip or pelvis, or all of these areas. There might be discomfort in the front of the pelvis if the pubic ramus has cracked. Usually, walking is difficult and painful. Other important tasks may be challenging to complete. You can feel pain when you touch your back or pelvis. You may find yourself with a restricted low back range of motion.

Causes

The most common factor in sacral insufficiency fractures is osteoporosis. Osteoporosis is characterized by a decreased bone mass. Calcium and other minerals found in bone tissue are diminished. The bones may become more brittle as a result. This makes them easier to break. A DEXA scan is used to calculate bone mineral density.   There are 25 million individuals in the USA who suffer from osteoporosis. About 80% of these are women.

A radiation treatment to the pelvis, the use of steroids, rheumatoid arthritis, thyroid dysfunction, eating disorders, liver transplantation, hypocalcemia, and Paget's disease are some of the other risk factors that might cause bone loss. Due to transient osteoporosis, sacral insufficiency fractures can also happen in women who are pregnant or nursing.

Healing Time

The majority of sacral fractures heal in 6 to 12 weeks. According to experts, surgery may be necessary if you fell from a height and also sustained additional injuries, such as nerve damage or damage to the blood vessels nearby. However, the healing process, in the vast majority of cases, proceeds without any problem.

Management

SIFs have mostly been treated with conservative management in the past. Early rehabilitation and physiotherapy, as well as extended bed rest and pain management, are the primary focuses of treatment. Early guidelines said that the person should not move around much for about 3 to 6 months after the fracture. However, recent research suggests that early mobilization may enhance outcomes and reduce problems. Deep vein thrombosis (DVT), diminished muscle strength, and heart dysfunction are among the risks associated with extended immobility. 

SIFs can also be treated using pharmacological medications. During recuperation, it is essential to manage pain, although this can be difficult. The most commonly used medications include acetaminophen, NSAIDs, and opioids. Although it remains debatable whether NSAIDs impair bone mineral density or delay fracture healing, many people use them.