Sacral Stress Fracture in Athletes With Overuse: A Clinical Series of 11 Patients and Literature Review.

Abstract

This was a narrative review. The purpose of this study was to report the physical and radiologic characteristics of sacral stress fractures in 11 athletes and to review the current literature on sacral stress fractures. Sacral stress fractures are rarely reported as a cause of low back pain in athletes. We retrospectively analyzed 11 athlete patients with sacral stress fractures and low back pain. All patients received conservative treatments, such as rest from sporting activities and physical therapy. Clinical data, such as age, sex, athletic activity, region of tenderness, and duration of low back pain, and radiologic data, such as information from plain radiographs and fracture lines on magnetic resonance imaging (MRI), were evaluated. The study included 11 athlete patients (5 males and 6 females) with sacral stress fractures, and their mean age was 18.7 years (range, 15-38y). The sports that caused the stress fractures were baseball, badminton, and basketball in 2 patients each and football, judo, marathon, volleyball, and dance in 1 patient each. All patients had tenderness on the sacrum. The mean duration of low back pain was 1.8 weeks (range, 1-4wk). Fracture lines on MRI were observed only in the caudal-ventral part of the sacrum in 7 patients and extended from the inferolateral angle of the sacrum to the superior lateral sacral alar in 4 patients. The study findings demonstrated that MRI and tenderness were useful for detecting the presence of sacral stress fractures in athletes. Moreover, fracture lines in the sacrum may progress from the caudal-ventral part of the sacrum to the cranio-dorsal direction.