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Archives of Orthopaedic and Trauma Surgery

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01-07-2018 | Trauma Surgery

Fragility fractures of the sacrum occur in elderly patients with severe loss of sacral bone mass

Authors: Daniel Wagner, Alexander Hofmann, Lukas Kamer, Takeshi Sawaguchi, R. Geoff Richards, Hansrudi Noser, Dominik Gruszka, Pol M. Rommens

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 7/2018

Abstract

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.

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Title: Fragility fractures of the sacrum occur in elderly patients with severe loss of sacral bone mass
Authors: Daniel Wagner
Alexander Hofmann
Lukas Kamer
Takeshi Sawaguchi
R. Geoff Richards
Hansrudi Noser
Dominik Gruszka
Pol M. Rommens
Publication date: 01-07-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 7/2018
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-2938-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Fragility fractures of the sacrum occur in elderly patients with severe loss of sacral bone mass

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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