BAKKER CLASSIFICATION IN TREATMENT OF SACRAL STRESS FRACTURES: A SINGLE CENTER EXPERIENCE

A B ST R A CT Objective: Sacral stress fractures mostly occur in patients with a compromised bone structure. Both surgical and nonsurgical modalities are used in the treatment of these patients. However, there is not a well-established treatment guideline. The purpose of this study was to evaluate whether the Bakker classification can be used as a guide when selecting a treatment modality for the treat sacral stress fractures. Materials and Methods: This retrospective study assessed 19 consecutive patients who were diagnosed with a sacral stress fracture. The patients’ demographics, imaging studies, treatment modalities and outcomes were extracted from their records. Imaging studies were re-evaluated according to the Bakker classification, and fractures were classified accordingly. Finally, the distribution of treatment modalities regarding fracture types was evaluated. Results: Three patients had type A sacral stress fractures, 11 had type B sacral stress fractures. Five patients, four of whom had prior lumbosacral fusion surgery, had type C fractures. All type A cases were relieved by conservative management. Eight type B fractures were treated by percutaneous procedures. All patients with type C fractures have undergone lumbopelvic fusion. The mean follow-up period was 31.2±18.9 months, and a marked reduction in pain was found after all therapeutic approaches. Conclusion: The management of sacral stress fractures primarily depends on the type of fracture. The authors recommend lumbopelvic fixation for fractures with prior lumbosacral instrumentation and conservative treatment for type A fractures. Though percutaneous sacroplasty is effective in type B fractures, some can be managed by conservative treatment, whereas others require percutaneous sacroiliac fusion. Further prospective studies with larger populations are needed to confirm the suggested fracture classification-based treatment algorithm.