A RARE CAUSE OF POSTPARTUM LOWER BACK PAIN: SACRUM STRESS FRACTURES

Objective: Although lower back pain is one of the most frequent complaints during pregnancy, a rare but very important cause is a sacral stress fracture.Although rarely seen, the condition should form one of the differential diagnoses for back pain during pregnancy and the postpartum.This study aims to present one of those uncommon causes of postpartum lower back pain in order to improve awareness and aid diagnosis.Materials and Methods: Six postpartum patients with no previous history of osteoporosis or trauma were diagnosed with sacral stress fractures.Of these, four presented within two weeks from delivery, and two presented three months after delivery (mean: 39.3 days).All patients had normal laboratory findings and bone mineral density, thus excluding metabolic bone diseases.All direct radiographs were normal, but magnetic resonance imaging (MRI) detected an isolated fracture of the wing of the sacrum in all cases.Results: Mean age of patients was 33 years (range: 30-35 years).All had pain in the sacral region, which was accentuated by weight-bearing and improved by rest.MRI revealed an isolated fracture of the sacral wing with no adjacent bony or soft tissue abnormality.Conservative management with activity modification, analgesia, and physiotherapy led to complete resolution within 8-12 weeks.Conclusion: Although less common, sacral stress fractures must be considered in the differential diagnosis in the postpartum period of low back pain.An early MRI study is crucial for an accurate diagnosis.Conservative treatment usually ensures complete recovery.This series highlights the need for early diagnosis and intervention to treat this uncommon condition.