Diagnosis and management of sacral insufficiency fractures

Sacral insufficiency fractures are pathologic fractures that occur in patients with abnormal bone quality. These injuries occur after low-energy trauma or repetitive physiologic loads. Historically, treatment of sacral insufficiency fractures was nonoperative with modified weightbearing and analgesia. Increased awareness to the potential morbidity and mortality associated with these injuries has led to multiple proposed interventions. Percutanous sacroplasty and screw fixation are the two most frequently performed procedures for sacral insufficiency fractures and involve placement of cement or screws, respectively, within the sacrum to stabilize these lesions. Although there is published literature to support both treatments, a validated classification system to describe sacral insufficiency fractures and comparative clinical data do not exist. The optimal treatment for sacral insufficiency fractures is dependent on the location, size, and chronicity of the lesion; consideration should also be given to the entire pelvic ring and contribution of the sacral insufficiency fracture to the stability of the bony pelvis.