title: Sacral insufficiency fractures: current concepts of management.
abstract: BACKGROUND
  Sacral insufficiency fractures (SIFs) are often overlooked in elderly patients presenting with low back and pelvic pain following no or minimal trauma.
  
  
  OBJECTIVE
  The aim of this review is to raise awareness and outline the clinical presentation, methods of diagnosis and treatment of SIFs.
  
  
  CONCLUSIONS
  Insufficiency fractures represent a special category of stress fractures that occur in bones with reduced mineral content and elastic resistance. SIFs, a well-defined subgroup of the latter group, are not uncommon, but lack of clinical suspicion results in many being undiagnosed. SIFs are set to become an important clinical entity of both social and economic significance as the Western population ages. Subtle clinical presentations and signs coupled with radiographic findings that can mimic other unrelated or overlapping conditions, such as sacroiliac joint infection, spinal stenosis and metastatic bone disease, often make SIF diagnosis a challenge. The aim of this review is to increase awareness among clinicians, highlighting SIFs as an important differential diagnosis to be considered when patients present with low back and pelvic pain and subsequently allow prompt management. The paper provides an overview of epidemiology, anatomical considerations, relevant pathophysiology and risk factors, presenting symptoms and signs, investigations and imaging techniques, differential diagnoses and current treatment methods available for the management of SIFs.
authors.affiliation: Academic Department of Trauma and Orthopedics, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: E
authors.initials: E
authors.lastname: Tsiridis
authors.forename: N
authors.initials: N
authors.lastname: Upadhyay
authors.forename: P V
authors.initials: PV
authors.lastname: Giannoudis
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D015775:Fractures, Stress / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D017048:Health Care Costs; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D010024:Osteoporosis / Q000150:complications; D011247:Pregnancy; D011877:Radionuclide Imaging; D012307:Risk Factors; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates