Sacral Facet Fractures in Elite Athletes

Abstract

Case series of elite athletes with sacral facet fractures. To report a case series of elite athletes with sacral facet fractures that may be an underrecognized career-ending injury. Injury of the posterior elements including spondylolysis and spondylolisthesis are well-known causes of back pain in the young athlete, but there has been only 1 previous case report of a sacral facet fracture. This study is a retrospective chart review of 3 elite athletes with severe back pain and sacral facet fractures. An 18-year-old gymnast with a 2-year history of back pain, a 14-year-old gymnast with a 6-month history of back pain, and a 14-year-old tennis player with a 18-year history of back pain. This series consists of 3 nationally competitive athletes with back pain severe enough to stop participation in sports. All patients had intra-articular sacral facet fractures proven by computed tomography, none of which were recognized on magnetic resonance imaging. Clinically, all had localized pain with back extension. Multiple tests and invasive procedures were performed without significant improvement prior to the correct diagnosis being made. Treatment with minimally invasive removal of the intra-articular fragments led to immediate pain relief and return to sport in 2 patients and transient though not long-lasting pain relief in the patient whose injury was undiagnosed for 2 years. Intra-articular sacral facet fractures may be an underrecognized and misdiagnosed career-ending injury in elite athletes. In patients who have localized pain with back extension, a computed tomographic scan, and not a magnetic resonance image, diagnosed this injury. Although this series is small, it seems that early recognition and treatment of sacral facet fractures maximize chances of pain resolution and return to sport.