Insufficiency fractures in patients with metabolic bone disease

Insufficiency fractures in patients with metabolic bone disease can occur:

1. with incidental or no trauma.
2. at the caudal end of spinal instrumentation constructs.

It typically presents with undiagnosed onset of back pain, often with normal radiographs.

Although patients may present with neurological symptoms such as sacral radiculopathy or change in bowel and bladder function, neurological symptoms are less common in these low energy fractures.

Diagnosis is often delayed and typically made by CT or MRI scans.

Nonoperative treatment consists of an extended period of bedrest. This is often poorly tolerated in this patient population (elderly, chronic illness).

Sacroplasty is an option for insufficiency sacral fractures.

Percutaneous iliosacral screw fixation usually provides sufficient stabilization to improve pain relieve and allow gradually progressive mobilization with minimal surgical risk.