Virginia Via Research Day Book 2026

Medical Student Research Case Reports

35 SACRAL ALAR STRESS FRACTURE

Brandon Chun OMS-III; Hope Gough OMS-II; Mary Mitchell, DO Corresponding author: bchun@vt.vcom.edu

VCOM Sports and Osteopathic Medicine, Blacksburg, Virginia

Kemp's were positive. Due to changes in exams, there was concern for pars injury and lumbosacral spine x-ray was ordered. The x-ray showed no evidence of abnormality. An MRI was ordered, but it was elected to proceed with rest, physical therapy, and meloxicam. After approximately a month, the patient reported improvement in symptoms but not complete relief. It was discussed to proceed with the MRI or a sacroiliac joint injection. The SI joint injection was elected which was tolerated very well. There was resolution of symptoms for only 24 hours. It was now stressed that the MRI needed to be obtained but was not completed until May 2025. The MRI showed a nondisplaced right sacral alar fracture, acute to subacute in appearance. A CT, DEXA scan, and bloodwork were ordered, and the patient was advised complete rest and cessation of physical activity. Blood work showed normal TSH, free T4, and ferritin. High alkaline phosphatase, total cholesterol, and triglycerides was found. Vitamin D and CBC were normal. DEXA scan showed normal bone mineral mass based on BMC/BMD z-scores. The CT showed a healed fracture.

Context: A 16-year-old Caucasian female gymnast presented to clinic with right hip pain and low back pain not caused by trauma. A sacral ala stress fracture as seen in this patient is important to review due to the rarity of the location and cause of the injury. While frequently reported in long distance runners, the literature contains limited discussion of these fractures in gymnasts. Report of Case: Patient presented with right hip pain in April 2024. Patient reports pain during activities that extend the hip. There was no history of inciting traumatic event. In September, the patient returned for a repeat examination as her symptoms were not resolving. Repeat examination of the right hip was again benign. On physical exam of lumbar spine, gait was normal and even, sensation was intact in L2-S1 dermatomes, and both patellar and Achilles reflexes were 2/4. Strength was 5/5 in hip flexion, knee extension, ankle dorsiflexion, EHL, and peroneals. There was tenderness over right quadratus lumborum, right transverse process of L5, and right sacroiliac joint. Range of motion was limited. Gillet Test, Yeoman's Test, and Seated

Comments: Generally, patients with sacral stress fractures have good outcomes with conservative treatments. Symptoms may improve after 1-2 weeks of treatment as shown in this case, but full resolution of symptoms may take 6-12 months. Such as in this case, often plain radiographs can only detect complete fractures. MRI is the gold standard in diagnosing sacral stress fractures but unfortunately in this case, it was obtained late relative to the presentation of symptoms. Methods: Sacral fractures and stress fractures were key words used to find the literature on this topic. Sources included Curr Osteoporos Rep, Arch Endocrinol Metab, Am J Sports Med, Med Sci Sports Exerc, Sci Rep, Clin Cases Miner Bone Metab, and Jouranal of Women’s Health. Diagnosis: The patient’s presentation, history, and tests led to the dianosis of a sacral alar stress fracture.

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