Management of Pregnancy-related Sacral Stress Fractures: 23 cases in a Single-center Experience

Abstract Purpose: This study aims to find out the incidence, etiology, and risk factors, define clinical features, show the magnetic resonance imaging (MRI) and laboratory findings and share the experience of treatment and clinical outcome of pregnancy-related sacral stress fractures (SSFs). Methods: In total, 29.241 (15.008 of them vaginal and 14.283 of them caesarean section delivery) women gave birth in our hospital between January 2016 and December 2021. Twenty-three of them (0.078%) who had low back and pelvic pain were diagnosed with SSFs using pelvic MRI. Dual-energy X-ray absorptiometry (DEXA) was used to rule out underlying osteopenia and osteoporosis and determine the type of SSFs. Results: To our knowledge, our study is the largest single-center study in the literature about SSFs related to pregnancy and is the first study regarding the incidence of pregnancy-related SSFs that was 0.078% (23/29.241patients). 73.91% of the patients were primigravida. Thirteen patients (56.52%) were classified as fatigue SSFs, eight (34.78%) were insufficiency SSFs, and only two (8.7%) were defined as a mixed type of SSFs Conclusions: Pregnancy-related SSFs are uncommon but should be considered by clinicians in the differential diagnosis of low-back and pelvic pain during pregnancy and the postpartum period. We determined that first pregnancy is a significant risk factor for SSFs. The current study also revealed that laboratory investigation of vitamin D deficiency or insufficiency and DEXA investigation, which may lead to osteoporosis or osteopenia, were crucial in the diagnosis. Furthermore, some SSFs should be reclassified as mixed fractures, fatigue, and insufficiency fractures.