Journal article
Fragility fractures of the sacrum occur in elderly patients with severe loss of sacral bone mass.
- Wagner D Department of Orthopaedics and Traumatology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany. wagner.daniel@gmx.ch.
- Hofmann A Department of Orthopaedics and Traumatology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany.
- Kamer L AO Research Institute Davos, Davos, Switzerland.
- Sawaguchi T Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan.
- Richards RG AO Research Institute Davos, Davos, Switzerland.
- Noser H AO Research Institute Davos, Davos, Switzerland.
- Gruszka D Department of Orthopaedics and Traumatology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany.
- Rommens PM Department of Orthopaedics and Traumatology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany.
- 2018-04-28
Published in:
- Archives of orthopaedic and trauma surgery. - 2018
Fragility fracture
Osteoporosis
Pelvis
Sacral insufficiency fracture
Sacrum
Statistical model
Aged
Aged, 80 and over
Bone Density
Bone Screws
Female
Fracture Fixation, Internal
Humans
Male
Middle Aged
Models, Statistical
Osteoporotic Fractures
Retrospective Studies
Sacrum
Spinal Fractures
Tomography, X-Ray Computed
English
INTRODUCTION
Patients suffering from osteoporosis-associated fragility fractures of the sacrum (FFS; also termed sacral insufficiency fractures) are increasingly observed. They have typical fracture patterns with fracture lines located in the sacral ala. When treating these patients operatively, iliosacral screw loosening is not uncommon. We aimed to study the sacral bone mass in patients presenting with a FFS using 3D statistical models.
MATERIALS AND METHODS
3D models of averaged Hounsfield units (HU) were generated based on CT scans from 13 patients with a unilateral FFS (mean age 79.6 years; 11 females, 2 males). The control group without fractures consisted of 28 males and 32 females (mean age of 68.3 years). A virtual bone probe along the trans-sacral corridors S1 and S2 was taken.
RESULTS
The bone mass distribution in the fractured sacra was similar to the control group, however, with overall lower HU. Large zones of negative HU were located in the sacral ala. In the fractured sacra, the HU in the sacral ala was significantly lower on the non-injured side when comparing to the fractured side (p < 0.001) as well as compared to the non-fractured group (p < 0.001). Low bone mass was observed in sacral body S1 (40 HU) and S2 (20 HU).
CONCLUSIONS
The extensive area of negative HU may explain the fracture location in the sacral ala. The low HU in the sacral bodies advocates the use of trans-sacral implants or augmented iliosacral screws to enhance the strength of fracture fixation. The increased HU in the fractured ala could be explained by fracture-asssociated hemorrhage and can be used as a diagnostic tool.
Patients suffering from osteoporosis-associated fragility fractures of the sacrum (FFS; also termed sacral insufficiency fractures) are increasingly observed. They have typical fracture patterns with fracture lines located in the sacral ala. When treating these patients operatively, iliosacral screw loosening is not uncommon. We aimed to study the sacral bone mass in patients presenting with a FFS using 3D statistical models.
MATERIALS AND METHODS
3D models of averaged Hounsfield units (HU) were generated based on CT scans from 13 patients with a unilateral FFS (mean age 79.6 years; 11 females, 2 males). The control group without fractures consisted of 28 males and 32 females (mean age of 68.3 years). A virtual bone probe along the trans-sacral corridors S1 and S2 was taken.
RESULTS
The bone mass distribution in the fractured sacra was similar to the control group, however, with overall lower HU. Large zones of negative HU were located in the sacral ala. In the fractured sacra, the HU in the sacral ala was significantly lower on the non-injured side when comparing to the fractured side (p < 0.001) as well as compared to the non-fractured group (p < 0.001). Low bone mass was observed in sacral body S1 (40 HU) and S2 (20 HU).
CONCLUSIONS
The extensive area of negative HU may explain the fracture location in the sacral ala. The low HU in the sacral bodies advocates the use of trans-sacral implants or augmented iliosacral screws to enhance the strength of fracture fixation. The increased HU in the fractured ala could be explained by fracture-asssociated hemorrhage and can be used as a diagnostic tool.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1007/s00402-018-2938-5
- PMID 29700604
- Persistent URL
- https://sonar.ch/global/documents/75304
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