Injuries to the sacrum are uncommon and often overlooked. Especially in the setting of severe traumatic injuries, sacral injuries often occur in conjunction with other more severe injuries to the pelvis and/or abdomen.
Traumatic
Traumatic fractures of the sacrum can occur in conjunction with other types of pelvic and spinal fractures. These injuries commonly occur as a result of serious high-energy injuries including motor vehicle collisions and severe falls. About half of traumatic sacral fractures are associated with injuries to the nerves that exit the lowest segments of the spinal cord.
Stress
A sacral stress fracture occurs in young, active patients, commonly seen in female long-distance runners. These injuries are closely related to sacral insufficiency fractures, but the bone is usually not osteoporotic. Rather than the bone not being healthy enough, the activities simply are too much for the sacrum to withstand, and a stress fracture results.
Symptoms of a sacral stress fracture most commonly include back and buttock pain, and pain with activities such as running. Treatment must include resting from activities that cause pain. Usually, with a period of rest, the symptoms will resolve. Gradual resumption of activities is important to prevent a recurrence.
Insufficiency
Sacral insufficiency fractures occur in elderly patients with osteoporosis. These injuries may be the result of a fall or the result of no particular injury. Patients commonly complain of symptoms of low back and buttock pain.
Sacral insufficiency fractures may not be seen on regular x-rays but typically show up on MRI or CT scans of the pelvis. The treatment of a sacral insufficiency fracture is usually symptomatic relief with rest and ambulatory devices such as a walker or cane.
