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Sacral insufficiency fractures: a case of mistaken identity

Authors Baldwin M, Tucker L

Received 5 January 2014

Accepted for publication 1 March 2014

Published 30 May 2014 Volume 2014:7 Pages 93—98


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Mathew J Baldwin, Laura J Tucker

Oxford Deanery, Oxford, UK

Introduction: Sacral insufficiency fractures are an important cause of lower back pain in the elderly. Clinically and radiologically, they must be distinguished from osseous metastases, which frequently coexist. To date, no case report has comprehensively explored the full range of diagnostic hurdles and potential pitfalls.
Case presentation: We report the case of a 70-year-old Caucasian female who presented to our services with a short history of progressive back pain without any history of trauma. A prior history of breast cancer was noted. Bone scintigraphy was initially reported as consistent with metastatic sacral deposits. Further characterization with magnetic resonance imaging and computed tomography revealed bilateral insufficiency fractures of the sacral alar. The patient responded well to conservative management.
Conclusion: To avoid misdiagnosis, particularly in those who are also at risk of osseous metastases, sacral insufficiency fractures must always be considered as a cause of lower back pain.

Keywords: sacral fractures, insufficiency fractures, misdiagnosis, metastatic disease

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