PELVIC INSUFFICIENCY: UNDERDIAGNOSED CONDITION, THERAPEUTIC DIAGNOSTIC REVIEW

Francisco Javier Sánchez García,Jorge Alberto De Haro Estrada,Herman Michael Dittmar Johnson

doi:10.1590/s1808-185120181702190995

Abstract

ABSTRACT Objective: The importance of sacral fractures has recently been recognized. However, its diagnosis is difficult, both clinically and through image, but there are more options for comprehensive diagnosis. Methods: We conducted a literature review about its diagnosis and the treatments currently offered, and also to check which treatments had the best results. Results: Patients with pelvic insufficiency have limited mobility due to lumbar or pelvic pain. As radiculopathy is a neurologically stable condition, it has a reported incidence of only 5% and sphincter disorders. The pain improves when lying down and increases with load. The treatments vary from conservative to surgical. Discussion: The different treatments were compared, and the one that has more morbidity is the conservative, because it predisposes us to complications (pneumonia, pulmonary embolism, deep vein thrombosis, heart failure, decubitus ulcers); in the interventionists we observe a faster improvement to normal activity of these patients, the complications are minor and the pain improvement is noticeable and much faster. Conclusion: Fractures due to pelvic insufficiency are underdiagnosed. However, there are already better imaging techniques and combined with good exploration and clinical history we can suspect this condition and offer the best possible treatment, these being the invasive ones that have had better results with lower morbidity and recovery of activity much more quickly. Level of Evidence III; Review of therapeutic studies - Investigation of treatment results.

Highlights

Back pain is common in elderly patients, but it can be difficult to determine its cause
We conducted a bibliographical review of articles, including reviews, meta-analyses, clinical trials, and even case presentations dedicated to this condition, in which we looked for timely diagnosis, as well as the different methods for it
Reviewing the different articles that speak extensively about this pathology, we were able to observe that in various articles the most frequently mentioned comorbidities associated with a higher percentage of Sacral insufficiency fractures (SIF) were osteoporosis, hypertension, diabetes, vitamin D deficiency, hypocalcemia, and nicotine abuse and the most often referenced complications of this condition were, in order of frequency, urinary tract infection, moderate pneumonia, depression, and thromboembolic events

Summary

Introduction

Back pain is common in elderly patients, but it can be difficult to determine its cause. Pelvic insufficiency fractures (PIF) are often overlooked in the elderly and in other groups at risk for structurally weakened bones with back and pelvic pain after zero- or low-energy trauma. They are difficult to diagnose at an early stage because there is usually no significant history of trauma, they are often accompanied by concurrent degenerative lower lumbar pathology, and routine radiographs of the sacrum do not adequately show them. SIF, in particular, is often overlooked in X-rays because the dislocation is minimal.[4]

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Discussion

Conclusion