Pelvis / Coccyx
Sacral Insufficiency Fracture
천골 부전골절
Insufficiency fracture of osteoporotic sacrum under physiologic load
- How common
- Common in elderly women (osteoporosis)
- Typical age
- Women 70+
What is it?
Osteoporotic sacrum fractures under physiologic loading, producing bilateral Honda-sign lines.
Commonly affected: Bilateral sacral alae with transverse connection
How it develops
- Low Bone DensityPostmenopausal or steroid-induced bone fragility
- Structural WeakeningCollapse of sacral trabecular network
- Insufficiency FractureFracture under physiologic loads
- Honda-Sign PatternBilateral sacral alae + transverse line (H-shape)
Symptoms
- Lumbosacral painLow back/buttock pain
- Worse with weight-bearingSevere with standing/walking
- Relieved lying downSupine decreases pain
- Gait difficultyFunctional decline, fall risk
- Groin radiationRadiates to groin if sacral roots irritated
How it is examined
- Sacral tendernessDirect tenderness over sacrum
- FABER / GaenslenReproduces SI/sacral pain
- Pelvic compression testIliac compression provokes pain
- Neurologic examUsually normal; rare S1–S4 radiculopathy
Imaging
X-ray low sensitivity, often normal — delayed diagnosis common.
- Usually normal
- Rare sclerotic line
- Possible associated pelvic changes
- Diagnostically insufficient
STIR MRI is gold standard — shows Honda sign (H-shaped edema) and fracture line.
- Bilateral sacral alar STIR hyperintensity
- Honda sign (H-shape)
- T1 hypointense fracture line
- Associated pelvic ring fracture possible
Non-surgical care
- Analgesia / restAcetaminophen, brief opioids as needed
- Osteoporosis therapyBisphosphonates, teriparatide, calcium, vit D
- Progressive WBPain-limited ambulation, fall prevention
- Physical therapyCore, pelvic floor, balance training
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Severe pain >6 weeks or unstable fracture
Procedures that may be discussed
- Percutaneous sacroplasty
- Percutaneous sacral screw fixation
Outlook
Most improve in 6–12 weeks; high recurrence — osteoporosis therapy essential.