Pubic and sacral insufficiency fractures: clinical course and radiologic findings

Distinctive vertical insufficiency fractures of the pelvis were found in nine osteopenic patients. Each patient had subacute pelvic pain without antecedent trauma. The sacral fractures healed fairly quickly, but the pubic fractures often had a protracted course. Eight patients had combined sacral and pubic fractures; one had only sacral alar fractures. In three patients the sacral fractures preceded the pubic fractures by 3-4 months. All nine patients had skeletal demineralization due to metabolic bone disease, radiation therapy, or multiple myeloma. Recognition of the association between pubic and sacral insufficiency fractures should aid in recognizing the diffuse nature of the skeletal disease so that unnecessary biopsy of the fracture sites can be avoided.