Clinical Rheumatology

, Volume 27, Supplement 2, pp 51–53 | Cite as

Post-partum sacral fracture associated with heparin treatment

  • Vincent Goëb
  • Victor Strotz
  • Mathieu Verdet
  • Xavier Le Loët
  • Olivier Vittecoq
Case Report

Abstract

We report the case of a 19-year-old woman who consulted for low-back pain 3 weeks after her first delivery. This young woman had a personal history of protein C deficiency and was treated daily during her pregnancy with low-molecular-weight heparin. Her body mass index was 34 and she only gained 10 kg during her pregnancy. Since the delivery – which occurred without any complication – she had suffered from a gradually increasing right-buttock pain and limp. Magnetic resonance imaging (MRI) revealed a fracture of the right sacral ala. After analgesia and 1 month of home relative bed rest, the patient recovered her functional capacities. Regarding our patient, who had no potential clinical risk factors for osteoporosis, the causal effect of heparin is thus possible but not certain. This case report illustrates the fact that clinicians should have a high suspicion of pelvic fracture in post-partum women, even in very young ones, presenting sudden onset of low back and pelvic pain, especially when they have received heparin during pregnancy. MRI seems to be the key exam because it is able to detect and stage fractures or microfractures.

Keywords

Fracture MRI Pregnancy 

References

  1. 1.
    McFarland EG, Giangarra C (1996) Sacral stress fractures in athletes. Clin Orthop Relat Res 329:240–243PubMedCrossRefGoogle Scholar
  2. 2.
    Klossner D (2000) Sacral stress fracture in a female collegiate distance runner: a case report. J Athl Train 35:453–457PubMedGoogle Scholar
  3. 3.
    Oliveri B, Gomez Acotto C, Mautalen C (1999) Osteomalacia in a patient with severe anorexia nervosa. Rev Rhum Engl Ed 66:505–508PubMedGoogle Scholar
  4. 4.
    Chiaruttini M (1987) Transverse sacral fracture with transient neurologic complication. Ann Emerg Med 16:111–113PubMedCrossRefGoogle Scholar
  5. 5.
    Schmid L, Pfirrmann C, Hess T et al (1999) Bilateral fracture of the sacrum associated with pregnancy: a case report. Osteoporos Int 10:91–93PubMedCrossRefGoogle Scholar
  6. 6.
    Dussa CU, El Daief SG, Sharma SD et al (2005) Atraumatic fracture of the sacrum in pregnancy. J Obstet Gynaecol 25:716–717PubMedCrossRefGoogle Scholar
  7. 7.
    Barbour LA, Kick SD, Steiner JF et al (1994) A prospective study of heparin-induced osteoporosis in pregnancy using bone densitometry. Am J Obstet Gynecol 170:862–869PubMedGoogle Scholar
  8. 8.
    Gouin-Thibault I, Pautas E, Siguret V (2005) Safety profile of different low-molecular weight heparins used at therapeutic dose. Drug Saf 28:333–349PubMedCrossRefGoogle Scholar
  9. 9.
    Sivakumaran M, Ghosh K, Zaidi Y et al (1996) Osteoporosis and vertebral collapse following low-dose, low molecular weight heparin therapy in a young patient. Clin Lab Haematol 18:55–57PubMedGoogle Scholar
  10. 10.
    Tsiridis E, Upadhyay N, Giannoudis PV (2006) Sacral insufficiency fractures: current concepts of management. Osteoporos Int 17:1716–1725PubMedCrossRefGoogle Scholar
  11. 11.
    Chao EY, Inoue N (2003) Biophysical stimulation of bone fracture repair, regeneration and remodelling. Eur Cell Mater 6:72–84PubMedGoogle Scholar
  12. 12.
    Judge JO, Kleppinger A, Kenny A et al (2005) Home based resistance training improves femoral bone mineral density in women on hormone therapy. Osteoporos Int 16:1096–1108PubMedCrossRefGoogle Scholar
  13. 13.
    Blake SP, Connors AM (2004) Sacral insufficiency fracture. Br J Radiol 77:891–896PubMedCrossRefGoogle Scholar
  14. 14.
    Kanberoglu K, Kantarci F, Cebi D et al (2005) Magnetic resonance imaging in osteomalacic insufficiency fractures of the pelvis. Clin Radiol 60:105–111PubMedCrossRefGoogle Scholar
  15. 15.
    Grangier C, Garcia J, Howarth NR et al (1997) Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof. Skeletal Radio 26:517–524CrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2008

Authors and Affiliations

  • Vincent Goëb
    • 1
  • Victor Strotz
    • 1
  • Mathieu Verdet
    • 1
  • Xavier Le Loët
    • 1
  • Olivier Vittecoq
    • 1
  1. 1.Department of Rheumatology, Rouen University Hospital & Inserm U905 (IFRMP 23), Institute for Biomedical ResearchUniversity of RouenRouen cedexFrance

Personalised recommendations