The presentation, diagnosis, and treatment of occult sacral fractures in
seventeen osteopenic patients were reviewed. Sixteen of the seventeen
patients were elderly women, and the fracture usually occurred without
trauma (fourteen patients). In ten patients, the sacral fracture was
associated with a fracture of the pubic ramus. The sacral fractures were
difficult to diagnose because nine patients also had a history of a
malignant lesion of the pelvis with or without radiation treatment.
Computed tomography and bone-scanning were diagnostic in all patients, but
magnetic resonance imaging was not specific. Use of crutches or a walker, a
reduction in activity, and use of non-narcotic analgesics allowed for the
resolution of symptoms in all twelve patients who did not have mitigating
conditions and permitted these patients to walk independently.