Die Stressfraktur des Kreuzbeins: MRT-gestützte Zeitskala des Heilungsprozesses einer oftmals fehldiagnostizierten Überlastungsverletzung bei Sportlern

The stress fracture of the sacrum is a commonly misdiagnosed overuse injury among athletes. Its initial latent symptoms are highly unspecific and usually manifest themselves as a “deep”, often unilateral pain in the lumbar spine / sacroiliac joint or buttock, hip and/or pelvis, respectively. A reliable diagnosis is only obtainable by MRI. This is discussed based on two case studies from 2016 (elite distance runner and amateur triathlete), along with the option of a conservative therapy including cross-training. By means of an accompanying MRI monitoring, the radiologic time scale of the physiologic bone remodeling process is obtained, yielding an edema volume half-life of 31 ± 7 days. In terms of therapy, particular attention is paid to employing a body-weight supported treadmill (“anti-gravity” treadmill / AlterG®). Comparing the individual courses of the two cases presented, it may be suggested that, if a sacral stress fracture is early diagnosed, adequately treated and followed up by a specific return to sports program, the athlete's recovery time and training backlog may be reduced.