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Sacral Insufficiency Fractures

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Vertebral Compression Fractures in Osteoporotic and Pathologic Bone

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Abstract

Sacral insufficiency fractures (SIF) are spontaneous, pathologic fractures of the sacrum that result when physiologic stress is placed on abnormal bone. While the true incidence is difficult to quantify, they are being increasingly recognized as a source of low back pain in the elderly population. Risk factors such as primary osteoporosis, conditions causing secondary osteoporosis (corticosteroids, Paget’s disease, hyperparathyroidism, etc.), malignancy, and pelvic irradiation can predispose to SIF. Diagnosis is often difficult given negative plain radiographs and the need for advanced imaging, and therefore a high degree of suspicion is warranted. While the majority of patients respond well to conservative therapy, these fractures can lead to significant pain and impairments in mobility. Surgical management is typically reserved for displaced fractures or those patients who have persistent pain despite non-operative treatment. Options include screw fixation of the posterior ring and more recently percutaneous sacroplasty.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA

    Nicholas Shepard

  2. Department of Orthopedics, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA

    Nirmal C. Tejwani

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  1. Nicholas Shepard
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Correspondence to Nirmal C. Tejwani .

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  1. Vice Chair and Residency Program Director, Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA

    Afshin E. Razi

  2. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Stuart H. Hershman

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Shepard, N., Tejwani, N.C. (2020). Sacral Insufficiency Fractures. In: Razi, A., Hershman, S. (eds) Vertebral Compression Fractures in Osteoporotic and Pathologic Bone. Springer, Cham. https://doi.org/10.1007/978-3-030-33861-9_19

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