[4-point internal fixator stabilization of a sacral insufficiency fracture]

Sacral insufficiency fractures develop due to a discrepancy between physiological load and load-bearing capacity. Besides osteoporosis as the main predisposing factor, other diseases lead to a loss of the bony elastic resistivity and therefore are able to cause these characteristic bilateral sacral stress fractures. Most patients complain of low back pain and show difficulties in mobilization.The non-operative therapy is based on analgesics and pain-adapted mobilization. Due to the noticeable functional deficit and persistent discomfort, surgery is necessary in many cases. Various operative methods are available, without significant differences regarding stability. We present the case of a 56-year-old man, in whom the progression of B-cell chronic lymphocytic leukemia (B-CLL) led to the development of osteolysis in the posterior pelvic ring and caused a sacral insufficiency fracture. Due to the progressive deterioration of mobilization and the persistent severe pain, we decided to stabilize the posterior pelvic ring. After surgery the patient could be mobilized and the pain was significantly reduced.