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Erschienen in: Osteoporosis International 4/2021

13.01.2021 | Concise Clinical Review

Postpartum bilateral sacral stress fracture without osteoporosis—a case report and literature review

verfasst von: Y. F. Wu, K. Lu, C. Girgis, M. Preda, V. Preda

Erschienen in: Osteoporosis International | Ausgabe 4/2021

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Abstract

Purpose

Sacral stress fractures are rare complications which can arise during pregnancy or in the early postpartum period. We report a case and discuss the findings of a confirmed postpartum sacral stress fracture in a 39-year-old multiparous woman and review previous case reports in the literature of sacral stress fracture related to pregnancy.

Methods

A review of the literature was conducted to examine the main characteristics of sacral stress fractures related to pregnancy. The Ovid/Medline, Embase and Google Scholar databases were searched with the inclusion criteria: human studies, English language, intrapartum, postpartum (within 6 months of parturition), sacrum and stress fracture. Our exclusion criteria included pubic fractures, vertebral fractures and non-English articles. The search terms included “stress fracture”, “postpartum”, “pregnancy”, “atraumatic” and the wildcard “sacr*”. Thirty-four cases were found and summarised in Table 2.

Results

A total of 65% of patients had onset of symptoms postpartum. Most patients did not have risk factors for sacral stress fractures including macrosomia, excessive pregnancy weight gain, heparin exposure, rapid vaginal delivery or predisposition to accelerated osteoporosis. Lumbar radiculopathy can be a feature of sacral stress fracture and it is more common (17.6%) than reported in the literature (2%). MRI is the preferred imaging modality for its safety profile in pregnancy and high sensitivity. A total of 70% reported normal bone mineral density (BMD). The mainstay treatment for sacral stress fractures includes relative bed rest, analgesia and modified weight-bearing exercises. Most patients have favourable outcome with complete symptom resolution.

Conclusion

Sacral stress fractures in the absence of osteoporosis are rare complications of pregnancy that can present with lumbar radiculopathy. Conservative management often produces good clinical outcomes.
Literatur
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Metadaten
Titel
Postpartum bilateral sacral stress fracture without osteoporosis—a case report and literature review
verfasst von
Y. F. Wu
K. Lu
C. Girgis
M. Preda
V. Preda
Publikationsdatum
13.01.2021
Verlag
Springer London
Erschienen in
Osteoporosis International / Ausgabe 4/2021
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-020-05788-0

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