title: Post-partum sacral fracture associated with heparin treatment.
abstract: We report the case of a 19-year-old woman who consulted for low-back pain 3 weeks after her first delivery. This young woman had a personal history of protein C deficiency and was treated daily during her pregnancy with low-molecular-weight heparin. Her body mass index was 34 and she only gained 10 kg during her pregnancy. Since the delivery - which occurred without any complication - she had suffered from a gradually increasing right-buttock pain and limp. Magnetic resonance imaging (MRI) revealed a fracture of the right sacral ala. After analgesia and 1 month of home relative bed rest, the patient recovered her functional capacities. Regarding our patient, who had no potential clinical risk factors for osteoporosis, the causal effect of heparin is thus possible but not certain. This case report illustrates the fact that clinicians should have a high suspicion of pelvic fracture in post-partum women, even in very young ones, presenting sudden onset of low back and pelvic pain, especially when they have received heparin during pregnancy. MRI seems to be the key exam because it is able to detect and stage fractures or microfractures.
authors.affiliation: Department of Rheumatology, Rouen University Hospital & Inserm U905 (IFRMP 23), Institute for Biomedical Research, University of Rouen, 76031 Rouen cedex, France. goebvince@yahoo.fr
authors.forename: Vincent
authors.initials: V
authors.lastname: Goëb
authors.forename: Victor
authors.initials: V
authors.lastname: Strotz
authors.forename: Mathieu
authors.initials: M
authors.lastname: Verdet
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loët
authors.forename: Olivier
authors.initials: O
authors.lastname: Vittecoq
mesh_terms: D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D020151:Protein C Deficiency / Q000188:drug therapy*; D012447:Sacrum / Q000293:injuries*; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult
chemical_list: D006495:Heparin, Low-Molecular-Weight