Abstract
Introduction
Low back pain (LBP) and hip pain frequently occur during pregnancy and postpartum period. Although pelvic and mechanic lesions of the soft tissues are most responsible for the etiology, sacral fracture is also one of the rare causes.
Case report
A 32-year-old primigravid patient presented with LBP and right hip pain which started 3 days after vaginal delivery. Although direct radiographic examination was normal, magnetic resonance imaging of the sacrum revealed sacral stress fracture. Lumbar spine and femoral bone mineral density showed osteoporosis as a risk factor. There were no other risk factors such as trauma, excessive weight gain, and strenuous physical activity. It is considered that the patient had sacral fatigue and insufficiency fracture in intrapartum period. The patient’s symptoms subsided in 3 months after physical therapy and rest.
Conclusion
In conclusion, sacral fractures during pregnancy and postpartum period, especially resulting from childbirth, are very rare. To date, there are two cases in the literature. In cases who even do not have risk factors related to vaginal delivery such as high birth weight infant and the use of forceps, exc., sacral fracture should be considered in the differential diagnosis of LBP and hip pain started soon after child birth. Pregnancy-related osteoporosis may lead to fracture during vaginal delivery.
References
Longhino V, Bonora C, Sansone V (2011) The management of sacral stress fractures, current concepts. Clin Cases Miner Bone Metab 8:19–23
Tsiridis E, Upadhyay N, Giannoudis PV (2006) Sacral insufficiency fractures: current concepts of management. Osteoporos Int 17:1716–1725
Pishnamaz M, Sellei R, Pfeifer R, Lichte P, Pape HC, Kobbe P (2012) Low back pain during pregnancy caused by a sacral stress fracture: a case report. J Med Case Rep 4:98
Karataş M, Başaran C, Özgül E, Tarhan Ç, Ağildere AM (2008) Postpartum sacral stress fracture: an unusual case of low back and buttock pain. Am J Phys Med Rehabil 87:418–422
Breuil V, Brocq O, Euller-Ziegler L, Grimaud A (1997) Insufficiency fracture of the sacrum revealing a pregnancy associated osteoporosis: first case report. Ann Rheum Dis 56:278–279
Goeb V, Strotz V, Verdet M, Le Loet X, Vittecog O (2008) Postpartum sacral fracture associated with heparin treatment. Clin Rheumatol 27:51–53
Thienpont E, Simon JP, Fabry G (1999) Sacral stress fracture during pregnancy: a case report. Acta Orthop Scand 70:525–526
O’Sullvian SM, Grey AB, Singh R, Reid IR (2006) Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos Int 17:1008–1012
Vujasinovic-Stupar N, Pejnovic N, Markovic L, Zlatanovic M (2002) Pregnancy associated spinal osteoporosis treated with bisphosphonates: long-term follow-up of maternal and infants outcome. Rheumatol Int 32:819–823
Tran HA, Petrovsky N (2002) Pregnancy associated osteoporosis with hypercalcemia. Intern Med J 32:481–485
Choe EU, Song JE, Park HK et al (2012) Effect of teriparatide on pregnancy and lactation associated osteoporosis with multiple vertebral fractures. J Bone Miner Metab 30:596–601
Rousiere M, Kahan A, Job-Deslandre C (2001) Postpartal sacral fracture without osteoporosis. Joint Bone Spine 68:71–73
Allonso-Burgos A, Royo P, Díaz L, Aquerreta JD (2007) Labor related sacral and pubic fractures. A case report. J Bone Joint Surg Am 89:396–398
Roller RL, Walker EA, Michelitch SW (2009) Postpartum sacral fracture in a 30-year-old female. Radiol Case Rep 4:264
Thein R, Burstein G, Shabshin N (2009) Labor related sacral stress fracture presenting as lower limb radicular pain. Orthopedics 32:447
Murray DJ, Bhatti W (2011) Maternal sacral fracture during delivery causing foot drop. Int J Gynaecol Obstet 115(3):289–290
De Burca N (2012) Low back pain postpartum a case report. Man Ther 17:597–600
Kardeli E, Uslu N (2009) Postpartum sacral fracture presenting as lumbar pain. J Women’s Health (Larchmt) 18:663–665
Lin JT, Lutz GE (2004) Postpartum sacral fracture presenting as lumbar radiculopathy: a case report. Arch Phys Med Rehabil 85:1358–1361
Sibilia J, Javier RM, Werle C, Kuntz JL (1999) Fracture of the sacrum in the absence of osteoporosis of pregnancy: a rare skeletal complication of the postpartum. Br J Obstet Gynaecol 106:1096–1097
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Öztürk, G., Külcü, D.G. & Aydoğ, E. Intrapartum sacral stress fracture due to pregnancy-related osteoporosis: a case report. Arch Osteoporos 8, 139 (2013). https://doi.org/10.1007/s11657-013-0139-y
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s11657-013-0139-y