Sacral stress fractures may present as low back or buttock pain, mimicking disk disease, sciatica, or sacroiliac joint pathology. These fractures more commonly affect the female runner; there are reports of adolescent female runners who had low back pain subsequently being diagnosed with sacral stress fractures

This emphasizes the need to consider stress injuries in the active pediatric patient population as well [87,88]. Imaging of sacral stress fractures may include nuclear scintigraphy, CT, and MRI. Bone scan classically shows uptake paralleling the sacroiliac joints. CT may show linear sclerosis with cortical interruption. MRI may show linear signal alteration paralleling the sacroiliac joints [89].

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