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Sacral Fatigue Fracture in a Military Recruit.
Matthew D Burgess1, Mickaila J Johnston, Eugene D Silverman
1From the *Department of Radiology, Naval Medical Center San Diego, San Diego, CA.
Clinical Nuclear Medicine
|April 19, 2017
Summary
A military recruit experienced hip pain due to a sacral fatigue stress fracture. Transitional lumbosacral anatomy may have predisposed him to this injury, highlighting the importance of advanced imaging for diagnosis.
Area of Science:
- Orthopedics
- Radiology
- Sports Medicine
Background:
- Hip and groin pain is common in young athletes and military personnel.
- Stress fractures, particularly in the sacrum, can be challenging to diagnose with initial imaging.
- Transitional lumbosacral anatomy is a recognized factor in spinal biomechanics.
Observation:
- A 19-year-old male military recruit presented with persistent left hip and groin pain after a twisting injury during a hike.
- Initial radiographs were negative, but a bone scan showed abnormal uptake in the left sacrum.
- SPECT/CT confirmed a left sacral fatigue stress fracture.
Findings:
- The sacral fracture was associated with transitional lumbosacral anatomy, specifically pseudoarticulation of the left S1 transverse process with the sacrum.
- This anatomical variation is postulated to have predisposed the recruit to the stress fracture.
- Differential diagnoses included unilateral sacroiliitis and sacral fracture.
Implications:
- This case highlights the utility of advanced imaging techniques like SPECT/CT in diagnosing obscure stress fractures.
- Recognizing transitional lumbosacral anatomy is crucial for identifying individuals at higher risk for sacral stress injuries.
- Early and accurate diagnosis is essential for appropriate management and return to activity in military recruits and athletes.