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Onen MR, Yuvruk E, Naderi S. Reliability and effectiveness of percutaneous sacroplasty in sacral insufficiency fractures. J Clin Neurosci 2015; 22:1601-8. [DOI: 10.1016/j.jocn.2015.03.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/04/2015] [Accepted: 03/08/2015] [Indexed: 12/17/2022]
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Sathiyakumar V, Shi H, Thakore RV, Lee YM, Joyce D, Ehrenfeld J, Obremskey WT, Sethi MK. Isolated sacral injuries: Postoperative length of stay, complications, and readmission. World J Orthop 2015; 6:629-635. [PMID: 26396939 PMCID: PMC4573507 DOI: 10.5312/wjo.v6.i8.629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/17/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate inpatient length of stay (LOS), complication rates, and readmission rates for sacral fracture patients based on operative approach.
METHODS: All patients who presented to a large tertiary care center with isolated sacral fractures in an 11-year period were included in a retrospective chart review. Operative approach (open reduction internal fixation vs percutaneous) was noted, as well as age, gender, race, and American Society of Anesthesiologists’ score. Complications included infection, nonunion and malunion, deep venous thrombosis, and hardware problems; 90-d readmissions were broken down into infection, surgical revision of the sacral fracture, and medical complications. LOS was collected for the initial admission and readmission visits if applicable. Fisher’s exact and non-parametric t-tests (Mann-Whitney U tests) were employed to compare LOS, complications, and readmissions between open and percutaneous approaches.
RESULTS: Ninety-four patients with isolated sacral fractures were identified: 31 (30.4%) who underwent open reduction and internal fixation (ORIF) vs 63 (67.0%) who underwent percutaneous fixation. There was a significant difference in LOS based on operative approach: 9.1 d for ORIF patients vs 6.1 d for percutaneous patients (P = 0.043), amounting to a difference in cost of $13590. Ten patients in the study developed complications, with no significant difference in complication rates or reasons for complications between the two groups (19.4% for ORIF patients vs 6.3% for percutaneous patients). Eight patients were readmitted, with no significant difference in readmission rates or reasons for readmission between the two groups (9.5% percutaneous vs 6.5% ORIF).
CONCLUSION: There is a significant difference in LOS based on operative approach for sacral fracture patients. Given similar complications and readmission rates, we recommend a percutaneous approach.
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Yoder K, Bartsokas J, Averell K, McBride E, Long C, Cook C. Risk factors associated with sacral stress fractures: a systematic review. J Man Manip Ther 2015; 23:84-92. [PMID: 26109829 DOI: 10.1179/2042618613y.0000000055] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to examine and identify risk factors associated with the development of sacral stress fractures in order to improve diagnosis in clinical practice. METHODS Electronic search strategies in PubMed, CINAHL, Scopus, and SPORTDiscus were combined with a hand search to identify articles for inclusion. Studies were considered if they described patient cases in which imaging confirmed diagnosis of a sacral stress fracture, and the diagnosis included whether the fracture was a sacral insufficiency or sacral fatigue stress fracture. RESULTS In those that developed sacral insufficiency fractures, the risk factors that were most prevalent included osteoporosis, pelvic radiation therapy, rheumatoid arthritis, long-term corticosteroid therapy, and postmenopausal, each with a prevalence of 100%. Risk factors with 100% prevalence in those diagnosed with sacral fatigue fractures included recent increase in training intensity and deficient diet. DISCUSSION A pattern of signs and symptoms are consistent among subjects with sacral stress fractures. Patients being unsuccessfully treated for low-back and buttock pain who fit the risk factor profiles for sacral stress fractures should be referred to a physician for further diagnostic workup.
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Affiliation(s)
- Kristi Yoder
- Department of Physical Therapy, Walsh University, North Canton, OH, USA
| | - Jenna Bartsokas
- Department of Physical Therapy, Walsh University, North Canton, OH, USA
| | - Kristina Averell
- Department of Physical Therapy, Walsh University, North Canton, OH, USA
| | - Erin McBride
- Department of Physical Therapy, Walsh University, North Canton, OH, USA
| | - Christine Long
- Department of Physical Therapy, Walsh University, North Canton, OH, USA
| | - Chad Cook
- Department of Physical Therapy, Walsh University, North Canton, OH, USA
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Wagner D, Ossendorf C, Gruszka D, Hofmann A, Rommens PM. Fragility fractures of the sacrum: how to identify and when to treat surgically? Eur J Trauma Emerg Surg 2015; 41:349-62. [PMID: 26038048 PMCID: PMC4523697 DOI: 10.1007/s00068-015-0530-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/07/2015] [Indexed: 12/29/2022]
Abstract
The increasing prevalence of fragility fractures of the sacrum (FFS) occurring predominantly in osteoporotic individuals poses a diagnostic and therapeutic challenge. The clinical presentation varies from longstanding low back pain without the patient remembering a traumatic event to immobilized patients after suffering a low-energy trauma. FFS are often combined with a fracture of the anterior pelvic ring; hence they are classified as a part of fragility fractures of the pelvis (FFP). If not displaced, the patients are treated with weight bearing as tolerated and analgesics; however, we advocate to treat displaced fractures surgically according to the fracture personality and the patient’s comorbidities. Surgical options include minimal invasive sacro-iliac screws, trans-sacral bar osteosynthesis, open reduction and internal fixation, or spinopelvic stabilization. In the light of the high complication rate associated with immobilized patients, an operative approach often is indicated to accelerate the patient’s mobility.
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Affiliation(s)
- D Wagner
- Department of Orthopaedics and Traumatology, University Medical Centre, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany,
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Kanezaki S, Rommens PM. Bilateral nonunion of the sacrum in a long-term paraplegic patient treated with trans-sacral bar and spinopelvic fixation. Arch Orthop Trauma Surg 2015; 135:345-9. [PMID: 25559304 DOI: 10.1007/s00402-014-2143-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Indexed: 12/27/2022]
Abstract
The incidence of fragility fractures of the pelvis is sharply increasing in accordance with growing life expectancy in developed countries. Numerous conditions may compromise bone density and quality, and paraplegia due to spinal cord injury is one of them. As screw anchorage is often problematic in poor bone stock, spinopelvic dissociation demands a type of osteosynthesis, which is less dependent on the density of trabecular bone. We present a case of a paraplegic 45-year-old man, with non-displaced bilateral nonunion of the sacrum. The patient was treated with trans-sacral bar and spinopelvic fixation. Rapid relief from pain and functional recovery was achieved with complete bone healing 1 year after the operation.
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Affiliation(s)
- Shozo Kanezaki
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany,
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56
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Nüchtern JV, Hartel MJ, Henes FO, Groth M, Jauch SY, Haegele J, Briem D, Hoffmann M, Lehmann W, Rueger JM, Großterlinden LG. Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures. Injury 2015; 46:315-9. [PMID: 25527459 DOI: 10.1016/j.injury.2014.10.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 05/29/2014] [Accepted: 10/14/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patients with a fracture in the anterior pelvic ring often simultaneously demonstrate pain in the posterior pelvic ring. The aim of the present prospective study was to assess the sensitivity of CT, MRI and clinical examination in the detection of fractures in the posterior pelvic ring in patients with fractures of the anterior pelvic ring diagnosed in conventional radiographs. METHODS Sixty patients with radiographic signs of an anterior pelvic ring injury were included in this prospective analysis. Following a focused clinical examination of the posterior pelvis, all patients underwent both a CT and then a MRI scan of their pelvis. Two board certified radiologists evaluated the CT and MRI scans independently. To estimate the presence of osteoporosis the Hounsfield units of the vertebral body of L5 were measured in each case. RESULTS Fifty-three women and seven men, with a mean age of 74.7+/-15.6 years were included into the study. A fracture of the posterior pelvic ring was found in fourty-eight patients (80%) patients using MRI. Fractures of the posterior pelvic ring would have been missed in eight cases (17%), if only CT had been used. Eighty-five percent of the patients with a posterior fracture had an osteoporosis. The majority of the cases suffered from a low energy trauma. Thirty-eight patients (83%) with positive clinical signs at the posterior pelvic ring actually had a fracture of the posterior pelvic ring in the MRI. The clinical examination proved to be equally effective to CT in detecting posterior pelvic ring fractures. CONCLUSION The significance of both, clinical examination and CT was confirmed in the detection of fractures in the posterior pelvic ring. MRI examination of the pelvis however, was found to be superior in detecting undislocated fractures in a cohort of patients with a high incidence of osteoporosis. Using MRI may be beneficial in select cases, especially when reduced bone density is suspected.
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Affiliation(s)
- J V Nüchtern
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - M J Hartel
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - F O Henes
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - M Groth
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - S Y Jauch
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, 21079 Hamburg, Germany
| | - J Haegele
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - D Briem
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - M Hoffmann
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - W Lehmann
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - J M Rueger
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - L G Großterlinden
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Abstract
Pelvic insufficiency fractures may occur in the absence of trauma or as a result of low-energy trauma in osteoporotic bone. With a growing geriatric population, the incidence of pelvic insufficiency fracture has increased over the last 3 decades and will continue to do so. These fractures can cause considerable pain, loss of independence, and economic burden to both the patient and the health care system. While many of these injuries are identified and treated based on plain radiographs, some remain difficult to diagnose. The role of advanced imaging in these cases is discussed. In addition to treating the fracture, medical comorbidities contributing to osteoporosis should be identified and corrected. Specific attention has been given to 25-OH serum vitamin D screening and repletion. Treatment generally consists of providing pain control and assisting patients with mobilization while allowing weight bearing as tolerated. In those unable to do so, invasive techniques such as sacroplasty as well as internal fixation may be beneficial. The role of operative fixation in insufficiency fractures is also discussed.
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Affiliation(s)
- Timothy J. O’Connor
- Regions Hospital, Department of Orthopaedic Surgery, University of Minnesota, Saint Paul, MN, USA
| | - Peter A. Cole
- Regions Hospital, Department of Orthopaedic Surgery, University of Minnesota, Saint Paul, MN, USA
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Eichler K, Zangos S, Mack MG, Marzi I, Vogl TJ. Outcome of long-axis percutaneous sacroplasty for the treatment of sacral insufficiency fractures with a radiofrequency-induced, high-viscosity bone cement. Skeletal Radiol 2014; 43:493-8. [PMID: 24453025 DOI: 10.1007/s00256-013-1811-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/27/2013] [Accepted: 12/25/2013] [Indexed: 02/02/2023]
Abstract
Our goal was to assess the technical results in patients who underwent long-axis sacroplasty for the treatment of sacral insufficiency fractures (SIF) by radiofrequency-induced high-viscosity bone cement augmentation. Twelve patients with bilateral sacral fractures were treated by augmentation with radiofrequency-activated, high-viscosity polymethylmethacrylate (PMMA) bone cement under local anesthesia. CT-guided sacroplasty was performed by using a long-axis approach through a single entry point. Thirty-six vertebrae were treated in 12 sessions under a combination of CT and fluoroscopic guidance using a bilateral access and a cavity-creating osteotome prior to remote-controlled, hydraulically driven cement injection. The visual analogue scale (VAS) score before sacroplasty and at 1 and 3 months after the treatment was obtained. PMMA leaks were evaluated retrospectively using the post-interventional CT. The mean amount of high-viscosity PMMA injected per patient was 7.8 ml. No major adverse events were observed. In the first 4 days after the procedure, the mean VAS score decreased from 8.1 ± 1.9 to mean 3.1 ± 1.2 and was followed by a gradual but continuous decrease throughout the rest of the follow-up period at 24 weeks (mean 2.2 ± 1.1) and 48 weeks (mean 2.1 ± 1.4). CT fluoroscopy-guided sacral augmentation was safe and effective in all 12 patients with osteoporotic SIF.
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Affiliation(s)
- Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University of Frankfurt, Frankfurt, Germany,
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59
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Park J, Ok E, Park HJ, Hong SH, Lee JI. Postpartum sacral stress fracture mimicking lumbar radiculopathy in a patient with pregnancy-associated osteoporosis. Ann Rehabil Med 2013; 37:582-5. [PMID: 24020042 PMCID: PMC3764356 DOI: 10.5535/arm.2013.37.4.582] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 09/19/2012] [Indexed: 11/06/2022] Open
Abstract
Postpartum sacral fracture is relatively rare, and its diagnosis is often delayed. We herein report such a case of a 28-year-old patient who presented with an insidious-onset lower back pain, left buttock pain, and radicular symptoms mimicking lumbar radiculopathy. Laboratory tests showed a decreased 25-hydroxy vitamin D level, and the bone mineral densitometry of both femurs was below the expected range. Plain radiographs of the lumbar spine and pelvis showed no definite abnormality, but lumbosacral spinal magnetic resonance imaging identified a left sacral fracture. Symptoms were alleviated with rest and oral analgesic treatment.
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Affiliation(s)
- Joohye Park
- Department of Rehabilitation Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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60
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61
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Barber SM, Livingston AD, Cech DA. Sacral radiculopathy due to cement leakage from percutaneous sacroplasty, successfully treated with surgical decompression. J Neurosurg Spine 2013; 18:524-8. [DOI: 10.3171/2013.2.spine12497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Percutaneous sacroplasty is a procedure adapted from vertebroplasty, which is designed to ameliorate the painful morbidity associated with sacral insufficiency fractures without the invasiveness of open surgery. Early estimates of efficacy, according to several case reports and small series, appear promising, but the procedure is not without risk. Several cases of radiculopathy due to nerve root compression by extravasated polymethylmethacrylate (PMMA) have been reported. The authors present a case of radiculopathy caused by cement leakage from sacroplasty, treated with surgical decompression of the compromised nerve root. The patient presented with left S-1 radiculopathy and was found on CT to have a left S-1 nerve root completely encased in PMMA over a portion of its length. The patient underwent sacral laminectomy with the removal of PMMA and experienced pain relief and the return of function postoperatively. Surgical removal of PMMA extravasated during sacroplasty is feasible and should be considered when nerve root compression or canal stenosis causes pain or neurological deficit refractory to conservative therapy.
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62
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Oztürk G, Külcü DG, Aydoğ E. Intrapartum sacral stress fracture due to pregnancy-related osteoporosis: a case report. Arch Osteoporos 2013; 8:139. [PMID: 23615864 DOI: 10.1007/s11657-013-0139-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 03/18/2013] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Low back pain (LBP) and hip pain frequently occur during pregnancy and postpartum period. Although pelvic and mechanic lesions of the soft tissues are most responsible for the etiology, sacral fracture is also one of the rare causes. CASE REPORT A 32-year-old primigravid patient presented with LBP and right hip pain which started 3 days after vaginal delivery. Although direct radiographic examination was normal, magnetic resonance imaging of the sacrum revealed sacral stress fracture. Lumbar spine and femoral bone mineral density showed osteoporosis as a risk factor. There were no other risk factors such as trauma, excessive weight gain, and strenuous physical activity. It is considered that the patient had sacral fatigue and insufficiency fracture in intrapartum period. The patient's symptoms subsided in 3 months after physical therapy and rest. CONCLUSION In conclusion, sacral fractures during pregnancy and postpartum period, especially resulting from childbirth, are very rare. To date, there are two cases in the literature. In cases who even do not have risk factors related to vaginal delivery such as high birth weight infant and the use of forceps, exc., sacral fracture should be considered in the differential diagnosis of LBP and hip pain started soon after child birth. Pregnancy-related osteoporosis may lead to fracture during vaginal delivery.
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Affiliation(s)
- Gülcan Oztürk
- Physical Medicine and Rehabilitation Department, Yeditepe University Hospital, Istanbul, Turkey.
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63
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Radiographically occult and subtle fractures: a pictorial review. Radiol Res Pract 2013; 2013:370169. [PMID: 23577253 PMCID: PMC3613077 DOI: 10.1155/2013/370169] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 02/20/2013] [Indexed: 11/17/2022] Open
Abstract
Radiographically occult and subtle fractures are a diagnostic challenge. They may be divided into (1) “high energy trauma fracture,” (2) “fatigue fracture” from cyclical and sustained mechanical stress, and (3) “insufficiency fracture” occurring in weakened bone (e.g., in osteoporosis and postradiotherapy). Independently of the cause, the initial radiographic examination can be negative either because the findings seem normal or are too subtle. Early detection of these fractures is crucial to explain the patient's symptoms and prevent further complications. Advanced imaging tools such as computed tomography, magnetic resonance imaging, and scintigraphy are highly valuable in this context. Our aim is to raise the awareness of radiologists and clinicians in these cases by presenting illustrative cases and a discussion of the relevant literature.
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64
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Abstract
Fragility fractures of the pelvis are common and the incidence is increasing with the aging population. The primary risk factor is osteoporosis. Diagnosis is challenging and advanced imaging with computed tomography (CT), bone scintigraphy, and magnetic resonance imaging (MRI) is helpful. These injuries result in significant morbidity, including prolonged hospitalization, immobility, and loss of autonomy in previously active patients. The mortality rate is high, similar to hip fracture patients. This problem is underappreciated and deserves attention. An opportunity exists to improve outcomes with medical and surgical management.
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Affiliation(s)
- Gillian L S Soles
- Department of Orthopaedic Surgery, UC Davis Medical Center, 4860 Y Street Suite 3800, Sacramento, CA, 95817, USA,
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65
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Rommens PM, Wagner D, Hofmann A. Surgical management of osteoporotic pelvic fractures: a new challenge. Eur J Trauma Emerg Surg 2012; 38:499-509. [PMID: 23162670 PMCID: PMC3495273 DOI: 10.1007/s00068-012-0224-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 08/24/2012] [Indexed: 11/24/2022]
Abstract
The number and variety of osteoporotic fractures of the pelvis are rapidly growing around the world. Such fractures are the result of low-impact trauma. The patients have no signs of hemodynamic instability and do not require urgent stabilization. The clinical picture is dominated by immobilizing pain in the pelvic region. Fractures may be located in both the ventral and the dorsal pelvic ring. The current well-established classification of pelvic ring lesions in younger adults does not fully reflect the criteria for osteoporotic and insufficiency fractures of the pelvic ring. Most osteoporotic fractures are minimally displaced and do not require surgical therapy. However, in some patients, an insidious progress of bone damage leads to complex displacement and instability. Therefore, vertical sacral ala fractures, fracture dislocations of the sacroiliac joint, and spinopelvic dissociations are best treated with operative stabilization. Angular stable bridge plating, the insertion of a transsacral positioning bar, and iliolumbar fixation are operative techniques that have been adapted to the low bone mineral density of the pelvic ring and the high forces acting on it.
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Affiliation(s)
- P M Rommens
- Department of Trauma Surgery, Center of Musculoskeletal Surgery, University Medical Center, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany
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66
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Kortman K, Ortiz O, Miller T, Brook A, Tutton S, Mathis J, Georgy B. Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency fractures or pathologic sacral lesions. J Neurointerv Surg 2012; 5:461-6. [DOI: 10.1136/neurintsurg-2012-010347] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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WU CHIACHIEH, WEI JAMESCHENGCHUNG, HSIEH CHENPU, YU CHENTUNG. Enhanced Healing of Sacral and Pubic Insufficiency Fractures by Teriparatide. J Rheumatol 2012; 39:1306-7. [DOI: 10.3899/jrheum.111458] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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68
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[Percutaneous iliosacral screw fixation for pelvis insufficiency fracture after implantation of a pedestal cup: case report]. Unfallchirurg 2012; 114:1115-9. [PMID: 21161150 DOI: 10.1007/s00113-010-1908-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Insufficiency fractures of the sacrum are frequently overlooked injuries especially in postmenopausal women with an osteoporotic bone structure and without a history of significant trauma. Plain radiographs are frequently inadequate in showing insufficiency fractures of the sacrum. Regarding this a fracture of a pubic ramus combined with appropriate clinical symptoms should raise the suspicion of a concomitant sacral injury. Therefore, further investigations including a CT scan are necessary.The case of an osteoporotic female patient with bilateral insufficiency fractures of the sacrum and a fracture of the right superior and inferior pubic ramus 5 weeks after primary total hip arthroplasty and implantation of a pedestal cup due to an intraoperative fracture of the right acetabulum is presented. To ensure early mobilization as well as avoidance of further concomitant morbidities a percutaneous iliosacral screw fixation was performed. This approach has been established as an operative treatment for minimally or non-displaced insufficiency fractures of the sacrum.
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69
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Alnaib M, Waters S, Shanshal Y, Caplan N, Jones S, St Clair Gibson A, Kader D. Combined pubic rami and sacral osteoporotic fractures: a prospective study. J Orthop Traumatol 2012; 13:97-103. [PMID: 22391943 PMCID: PMC3349020 DOI: 10.1007/s10195-012-0182-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 01/31/2012] [Indexed: 12/15/2022] Open
Abstract
Background Pelvic osteoporotic fractures (POFs) are often associated with considerable morbidity and mortality mainly as a result of infections and cardiovascular events. Patients usually need prolonged institutionalization, rehabilitation, and follow-up, with a high rate of dependency and cost. The most common sites of POFs include the pubic rami, sacrum, ilium, and acetabulum. Combined pubic rami (PROFs) and sacral osteoporotic fractures (SOFs) have been reported, mostly in retrospective studies, describing the mechanism of injury and incidence. The aim of this study was to evaluate the association between PROFs and SOFs and to assess the effect of combined PROFs and SOFs on patients’ mobility, discharge destination, and length of stay. Materials and methods We prospectively studied 67 patients with low-impact PROFs and/or SOFs. There were 54 (80.4%) female and 13 (19.6%) male patients, and the average age was 87.5 (range 65–96) years. All patients were assessed by the fracture liaison service. Patients had magnetic resonance imaging or bone scan when there was history of low back pain following the injury or lumbosacral tenderness on clinical examination. Results The mean length of stay for all patients was 45 (±35) days. Mortality rate was 10.4%. A significant relationship was found between low back pain and a positive finding of sacral fracture. Patients with combined PROFs and SOFs showed significantly longer length of stay than those with isolated PROFs. Conclusions The presence of low back pain and tenderness in patients who had low-impact pelvic injuries was highly suggestive of the presence of an associated SOF. There was a high association between sacral and PROFs. The length of stay of patients with PROFs associated with sacral osteoporotic fractures was significantly longer than that of patients with PROFs only. Therefore, we recommend considering the high association between SOFs and PROFs in planning the management and rehabilitation of patients with POFs.
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Affiliation(s)
- M Alnaib
- Gateshead Health NHS Foundation Trust, Gateshead, UK.
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70
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Re: Groin pain in sacral insufficiency fracture. Avoiding delayed diagnosis. INT J OSTEOPATH MED 2012. [DOI: 10.1016/j.ijosm.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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71
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Shah RV. Sacral kyphoplasty for the treatment of painful sacral insufficiency fractures and metastases. Spine J 2012; 12:113-20. [PMID: 22405614 DOI: 10.1016/j.spinee.2012.01.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 11/17/2011] [Accepted: 01/22/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Sacral insufficiency fractures and metastases are a source of severe intractable pain, with limited therapeutic options. Sacroplasty has demonstrable efficacy and safety; sacral kyphoplasty, however, is rarely reported. PURPOSE To evaluate the safety and efficacy of sacral kyphoplasty for sacral insufficiency fractures and metastases. STUDY DESIGN Retrospective, with long-term follow-up; rural community-based practice. PATIENT SAMPLE Patients with sacral insufficiency fractures and metastases. OUTCOME MEASURES Numerical pain rating scale, opioid equivalent usage. SELF-REPORT MEASURE: Numerical pain rating scale. FUNCTIONAL MEASURE: Opioid equivalent consumption. METHODS Retrospective analysis. RESULTS Statistically significant improvement in pain; overall, an improvement in opioid consumption. CONCLUSIONS Sacral kyphoplasty appears to be a safe and efficacious procedure, comparable to sacroplasty, in the treatment of SIFs and sacral metastases.
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Affiliation(s)
- Rinoo V Shah
- Department of Anesthesiology, Guthrie Clinic-Big Flats, 31 Arnot Rd, Horseheads, NY 14845, USA.
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72
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Trouvin AP, Alcaix D, Somon T, Zarnitsky C. Analgesic effect of sacroplasty in osteoporotic sacral fractures: a study of six cases. Joint Bone Spine 2012; 79:500-3. [PMID: 22284609 DOI: 10.1016/j.jbspin.2011.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To evaluate the short-term analgesic effect of sacroplasty in patients with osteoporotic sacral fractures. METHODS Single-center retrospective observational study of all patients managed with sacroplasty for osteoporotic sacral fractures between October 2008 and November 2009. For each patient, symptom duration, pain intensity, and analgesic consumption were recorded. Sacroplasty was performed under local analgesia, in the prone position, with computed tomography guidance. The long-axis approach was sued to introduce the needles and polymethylmethacrylate cement along the fracture line(s). Pain was evaluated on a 10-point visual analog scale (VAS) 24 hours before sacroplasty then at the time of weight-bearing resumption 24 hours after the procedure. Hospital stay length before and after the procedures were recorded. RESULTS We identified six patients (five women and one man) with a mean age of 83.2 years. All six patients presented with low back pain and four also had buttock pain. The interval from pain onset to diagnosis ranged from 1 month to 1 year. All patients reported that pain onset followed a fall. The mean VAS pain score was 8.2 before sacroplasty and decreased by 7.6 points 24 hours after the procedure (with four patients having a score of 0). Mean hospital stay length were 12 days before and 4 days after sacroplasty. All patients required opioid analgesics before sacroplasty. At discharge, analgesic requirements were a step II analgesic in one patient, acetaminophen in one patient, and no analgesics in four patients. No adverse events were recorded. DISCUSSION The findings from our small population are consistent with a recent literature review of 15 case-series studies showing a significant analgesic effect of sacroplasty. The rapid effect of sacroplasty allows prompt ambulation, thus avoiding complications related to immobility. CONCLUSION Sacroplasty is effective in relieving pain due to sacral insufficiency fractures.
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Affiliation(s)
- Anne-Priscille Trouvin
- Service de Rhumatologie, Groupe Hospitalier du Havre, Hôpital Jacques-Monod, 29 avenue Pierre-Mendès-France, 76290 Montivilliers, France
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73
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F-18 fluoride PET/CT in the detection of radiation-induced pelvic insufficiency fractures. Clin Nucl Med 2011; 36:e146-9. [PMID: 21892028 DOI: 10.1097/rlu.0b013e31821a293b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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74
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Ungaro E, Astore F, Bonora C, Ferrari MC. Groin pain in sacral insufficiency fracture. Avoiding delayed diagnosis. INT J OSTEOPATH MED 2011. [DOI: 10.1016/j.ijosm.2011.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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75
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Kang SE, Lee JW, Kim JH, Park KW, Yeom JS, Kang HS. Percutaneous sacroplasty with the use of C-arm flat-panel detector CT: technical feasibility and clinical outcome. Skeletal Radiol 2011; 40:453-60. [PMID: 20473493 DOI: 10.1007/s00256-010-0959-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Revised: 04/18/2010] [Accepted: 04/20/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE Sacroplasty for sacral insufficiency fractures (SIFs) has been performed mostly under computed tomography (CT) or fluoroscopy guidance. The purposes of this study are to describe technical tips and clinical outcomes of sacroplasty under C-arm flat panel detector CT (C-arm CT) guidance, and to compare the cement distributions shown on C-arm CT with those on multi-detector CT (MDCT). MATERIALS AND METHODS This study consisted of patients who underwent sacroplasty for SIF using C-arm CT from May 2006 to May 2009. Technical success was assessed in terms of cement filling and leakage. Clinical outcome was assessed at short-term (less than 1 month) and long-term (more than 1 month) follow-up using a four-grade patient satisfaction scale: poor, fair, good, and excellent. After sacroplasty, all patients underwent MDCT and three radiologists compared MDCT images with C-arm CT images in consensus, focusing on the cement distribution and cement leakage. RESULTS Sacroplasties were performed on both sacral alae in all 8 patients (male:female = 2:6, mean age = 76.9, range = 63-82). The technical success rate was 100%. At short-term follow up, 6 patients (87.5%) reported significant improvement. Five patients (62.5%) were available for long-term follow-up and all 5 patients reported a reduced pain and an improved ability to ambulate. Using MDCT as the standard of reference, the cement distribution was visualized equally well by C-arm CT. CONCLUSION Sacroplasty under C-arm CT showed excellent technical success and good clinical outcome. There was an excellent correlation between C-arm CT and MDCT in evaluating cement distribution and cement leakage.
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Affiliation(s)
- Sung Eun Kang
- Department of Radiology, Seoul National University Bundang Hospital, 300 Gumidong, Bundang-Gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.
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76
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Gänsslen A. [Biomechanical principles for treatment of osteoporotic fractures of the pelvis]. Unfallchirurg 2010; 113:272-80. [PMID: 20309516 DOI: 10.1007/s00113-010-1763-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fractures of the pelvis are of increasing interest, especially in older patients due to the often concomitant osteoporosis. The low bone quality can be a problem in several fixation situations. In this review the present and relevant literature on biomechanical data of unstable pelvic ring injuries and all biomechanical data dealing with osteosynthesis for acetabular fractures are discussed.
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Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Neurotraumatologie, Allgemeines Krankenhaus Celle, Siemensplatz 4, 29223, Celle, Deutschland.
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77
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Galbraith JG, Butler JS, Blake SP, Kelleher G. Sacral insufficiency fractures: an easily overlooked cause of back pain in the ED. Am J Emerg Med 2010; 29:359.e5-6. [PMID: 20675092 DOI: 10.1016/j.ajem.2010.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022] Open
Abstract
Sacral insufficiency fractures are an important and treatable cause of severe back pain. Despite publication of several case reports since its original description in 1982, awareness of these injuries remains inadequate in emergency medicine. Most patients are elderly women presenting with intractable lower back pain. Postmenopausal osteoporosis is the most significant risk factor. Marked sacral tenderness is common. Neurologic impairment is rarely detectable. Routine radiography of the spine and pelvis is usually inconclusive. Computed tomography remains the diagnostic modality of choice. Treatment is usually conservative.
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Affiliation(s)
- John G Galbraith
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland.
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78
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Dotchin C, Colman A, Shanshal Y. Bladder rupture following osteoporotic pubic ramus and sacral insufficiency fractures. Age Ageing 2010; 39:511-2. [PMID: 20494898 DOI: 10.1093/ageing/afq046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We present a case report of an 86-year-old lady with pubic ramus and sacral insufficiency fractures who developed extra-vesical bladder rupture following displacement of the pubic ramus fracture, a very unusual complication.
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79
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80
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Sacral insufficiency fracture: a masquerader of diskogenic low back pain. PM R 2010; 2:162-4. [PMID: 20193946 DOI: 10.1016/j.pmrj.2009.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Revised: 11/08/2009] [Accepted: 11/19/2009] [Indexed: 11/22/2022]
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81
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Choi KM, Song JH, Ahn SK, Choi HC. Therapeutic considerations of percutaneous sacroplasty for the sacral insufficiency fracture. J Korean Neurosurg Soc 2010; 47:58-63. [PMID: 20157381 DOI: 10.3340/jkns.2010.47.1.58] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 06/19/2009] [Accepted: 11/30/2009] [Indexed: 11/27/2022] Open
Abstract
Sacral insufficiency fracture is a debilitating injury not easily found in general radiologic examinations and is rarely diagnosed, since its symptoms are obscure. It is known to frequently occur in patients with osteoporosis, but the treatment has not yet been established and various kinds of treatment methods are being attempted. Sacroplasty is sometimes performed by applying percutaneous vertebroplasty which is known to be a less invasive treatment. Since the course of diagnosis of sacral insufficiency fracture is difficult and clear guidelines for treatments have not yet been established, many spine surgeons fail to diagnose patients or speculate on treatment methods. We report our experience in diagnosing a sacral insufficiency fracture in a 54-year-old healthy female patient using MRI and treating her with sacroplasty. From a therapeutic point of view, we then cover the usefulness, effects and characteristics relating to the complications of sacroplasty, along with literature review.
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Affiliation(s)
- Kyung-Mi Choi
- Department of Neurosurgery, Sacred Heart Hospital, College of Medicine, The Hallym University of Korea, Anyang, Korea
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82
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Leung ASO, Gordon LM, Skrinskas T, Szwedowski T, Whyne CM. Effects of bone density alterations on strain patterns in the pelvis: Application of a finite element model. Proc Inst Mech Eng H 2009; 223:965-79. [DOI: 10.1243/09544119jeim618] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Insufficiency fractures occur when physiological loads are applied to bone deficient in mechanical resistance. A better understanding of pelvic mechanics and the effect of bone density alterations could lead to improved diagnosis and treatment of insufficiency fractures. This study aimed to develop and validate a subject-specific three-dimensional (3D) finite element (FE) model of a pelvis, to analyse pelvic strains as a function of interior and cortical surface bone density, and to compare high strain regions with common insufficiency fracture sites. The FE model yielded strong agreement between experimental and model strains. By means of the response surface method, changes to cortical surface bone density using the FE model were found to have a 60 per cent greater influence compared with changes in interior bone density. A small interaction was also found to exist between surface and interior bone densities (< 3 per cent), and a non-linear effect of surface bone density on strain was observed. Areas with greater increases in average principal strains with reductions in density in the FE model corresponded to areas prone to insufficiency fracture. Owing to the influence of cortical surface bone density on strain, it may be considered a strong global (non-linear) indicator for insufficiency fracture risk.
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Affiliation(s)
- A S O Leung
- Orthopaedic Biomechanics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - L M Gordon
- Orthopaedic Biomechanics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - T Skrinskas
- Orthopaedic Biomechanics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - T Szwedowski
- Orthopaedic Biomechanics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - C M Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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83
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Thomas E, Cyteval C, Herisson C, Leonard L, Blotman F. Osteoporotic fracture of the sacrum: Sacroplasty and physical medecine. Ann Phys Rehabil Med 2009; 52:427-35. [DOI: 10.1016/j.rehab.2009.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 01/31/2009] [Indexed: 11/26/2022]
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Jha RM, Yoo AJ, Hirsch AE, Growney M, Hirsch JA. Predictors of Successful Palliation of Compression Fractures with Vertebral Augmentation: Single-center Experience of 525 Cases. J Vasc Interv Radiol 2009; 20:760-8. [PMID: 19465306 DOI: 10.1016/j.jvir.2009.01.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 01/21/2009] [Accepted: 01/26/2009] [Indexed: 10/20/2022] Open
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85
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Sacroplasty in a cadaveric trial: comparison of CT and fluoroscopic guidance with and without balloon assistance. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:1226-33. [PMID: 19387703 DOI: 10.1007/s00586-009-1001-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 02/08/2009] [Accepted: 04/08/2009] [Indexed: 10/20/2022]
Abstract
Sacral insufficiency fractures can cause severe, debilitating pain to patients concerned. The incidence of this fracture type correlates with the appearance of osteoporosis in the elderly population. A polymethylmethacrylate (PMMA) cement injection procedure called sacroplasty has been recently described as an optional method for the treatment of this fracture type. However, the correct cement placement in the complex anatomical structure of the sacrum is a surgical challenge. The aim of the study is to compare the precision, safety, and radiation exposure of standard multiplanar fluoroscopy and computed tomography (CT) guidance for PMMA application to the sacrum using both balloon-assisted sacroplasty and conventional sacroplasty. A controlled experimental investigation in a human cadaver trial has been performed. Two imaging and two application modalities to monitor percutaneous PMMA injection to the sacrum were examined. The application forms were randomized from side to side of the pelvis. We found less cement extravasation in the CT-guided groups, but also a significant higher radiation exposure (P < 0.05) by using CT guidance. The conventional fluoroscopy-guided sacroplasty revealed the shortest procedure time (incision to closure time) of all treatment groups (P < 0.01). These findings show no difference regarding cement extravasation between ballon-assisted and conventional sacroplasty. Further, in comparison to fluoroscopy-assisted technique, the CT-guided cement injection seems to decrease the risk of cement extravasation, irrespective of the use of an additional balloon assistance. However, we have to consider a greater radiation exposure using CT guidance. Further investigations will proof the suitability in the normal course of clinical life.
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86
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Lever M, Lever E, Lever EG. Rethinking osteoporotic sacral fractures. Injury 2009; 40:466. [PMID: 19070845 DOI: 10.1016/j.injury.2008.06.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 06/23/2008] [Indexed: 02/02/2023]
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87
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88
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Sacral insufficiency fractures after preoperative chemoradiation for rectal cancer: incidence, risk factors, and clinical course. Int J Radiat Oncol Biol Phys 2009; 74:818-23. [PMID: 19147305 DOI: 10.1016/j.ijrobp.2008.08.054] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 08/21/2008] [Accepted: 08/26/2008] [Indexed: 11/20/2022]
Abstract
PURPOSE Sacral insufficiency (SI) fractures can occur as a late side effect of pelvic radiation therapy. Our goal was to determine the incidence, risk factors, and clinical course of SI fractures in patients treated with preoperative chemoradiation for rectal cancer. MATERIALS AND METHODS Between 1989 and 2004, 562 patients with non-metastatic rectal adenocarcinoma were treated with preoperative chemoradiation followed by mesorectal excision. The median radiotherapy dose was 45 Gy. The hospital records and radiology reports of these patients were reviewed to identify those with pelvic fractures. Radiology images of patients with pelvic fractures were then reviewed to identify those with SI fractures. RESULTS Among the 562 patients, 15 had SI fractures. The 3-year actuarial rate of SI fractures was 3.1%. The median time to SI fractures was 17 months (range, 2-34 months). The risk of SI fractures was significantly higher in women compared to men (5.8% vs. 1.6%, p = 0.014), and in whites compared with non-whites (4% vs. 0%, p = 0.037). On multivariate analysis, gender independently predicted for the risk of SI fractures (hazard ratio, 3.25; p = 0.031). Documentation about the presence or absence of pain was available for 13 patients; of these 7 (54%) had symptoms requiring pain medications. The median duration of pain was 22 months. No patient required hospitalization or invasive intervention for pain control. CONCLUSIONS SI fractures were uncommon in patients treated with preoperative chemoradiation for rectal cancer. The risk of SI fractures was significantly higher in women. Most cases of SI fractures can be managed conservatively with pain medications.
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90
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Lee YJ, Bong HJ, Kim JT, Chung DS. Sacral insufficiency fracture, usually overlooked cause of lumbosacral pain. J Korean Neurosurg Soc 2008; 44:166-9. [PMID: 19096670 DOI: 10.3340/jkns.2008.44.3.166] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 08/10/2008] [Indexed: 11/27/2022] Open
Abstract
Sacral insufficiency fractures are usually known to develop in elderly patients with osteoporosis without definite trauma history. It is difficult to diagnose the sacral insufficiency fracture at an early stage because lower lumbar diseases, concurrently or not, may also be presented with similar symptoms and signs. We report a rare case of sacral insufficiency fracture who was not diagnosed initially but, instead, showed progressively worsening of clinical symptoms and radiological findings after decompression surgery for upper level lumbar stenosis.
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Affiliation(s)
- Yong-Jeon Lee
- Department of Neurosurgery, Our Lady of Mercy Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
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91
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Computer assisted percutaneous placement of augmented iliosacral screws: a reasonable alternative to sacroplasty. Spine (Phila Pa 1976) 2008; 33:1497-500. [PMID: 18520946 DOI: 10.1097/brs.0b013e318175c25c] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A technical report of fluoroscopy guided placement of augmented iliosacral screws in osteoporotic insufficiency fractures of the sacrum. OBJECTIVE To describe a combined approach of navigated iliosacral screw placement and screw augmentation as an option for osteosynthesis of sacral insufficiency fractures in the elderly. SUMMARY OF BACKGROUND DATA The incidence of sacral insufficiency fractures is increasing. Outcome of conservative treatment is inconsistent. Recently sacroplasty is propagated as an interventional therapy but the long-term outcome is still unknown. Evidence from finite element models suggests that stabilization of the sacrum achieved by sacroplasty is insufficient to restore the weight bearing capacity of the sacrum permanently. METHODS We suggest a minimally invasive fluoroscopically navigated iliosacral screw osteosynthesis with cement augmentation of the screws for treatment of insufficiency fractures of the sacrum. RESULTS The procedure, especially fluoroscopic visualization and navigation of the osteoporotic sacrum is technically feasible. A total radiograph time of 7,4 minutes, including image acquisition for navigation and fluoroscopic control of cement injection, is acceptable and can be expected to be significantly reduced with repeated applications of the procedure. The patient presented in the report was discharged to rehabilitation soon after the operation. An assistive device (delta wheel) is only needed for longer walking distances. Pain was reduced drastically immediately after surgery. CONCLUSION In general, fractures are treated by reduction and fixation to restore the biomechanical function of the injured bone. These principles should be applied to elderly patients with osteoporotic fractures as well. The technique reported here is adapted to the special demands of the elderly patient, i.e., minimally invasive, support of the weakened bone by cement augmentation, bone protective screw positioning and safety due to navigation support.
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92
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Goëb V, Strotz V, Verdet M, Le Loët X, Vittecoq O. Post-partum sacral fracture associated with heparin treatment. Clin Rheumatol 2008; 27 Suppl 2:S51-3. [DOI: 10.1007/s10067-008-0898-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 04/02/2008] [Indexed: 10/22/2022]
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Tsiridis E, Upadhyay N, Gamie Z, Giannoudis PV. Percutaneous screw fixation for sacral insufficiency fractures. ACTA ACUST UNITED AC 2007; 89:1650-3. [DOI: 10.1302/0301-620x.89b12.19058] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sacral insufficiency fractures are traditionally treated with bed rest and analgesia. The importance of early rehabilitation is generally appreciated; but pain frequently delays this, resulting in prolonged hospital stay and the risk of complications related to immobility. We describe three women with sacral insufficiency fractures who were treated with percutaneous sacroiliac screws and followed up for a mean of 18 months (12 to 24). They had immediate pain relief, uncomplicated rehabilitation and uneventful healing.
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Affiliation(s)
- E. Tsiridis
- Academic Department of Trauma & Orthopaedics Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, School of Medicine, Leeds University, Great George Street, Leeds LS1 3EX, UK
| | - N. Upadhyay
- Academic Department of Trauma & Orthopaedics Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, School of Medicine, Leeds University, Great George Street, Leeds LS1 3EX, UK
| | - Z. Gamie
- Academic Department of Trauma & Orthopaedics Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, School of Medicine, Leeds University, Great George Street, Leeds LS1 3EX, UK
| | - P. V. Giannoudis
- Academic Department of Trauma & Orthopaedics Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, School of Medicine, Leeds University, Great George Street, Leeds LS1 3EX, UK
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Whitlow CT, Mussat-Whitlow BJ, Mattern CWT, Baker MD, Morris PP. Sacroplasty versus vertebroplasty: comparable clinical outcomes for the treatment of fracture-related pain. AJNR Am J Neuroradiol 2007; 28:1266-70. [PMID: 17698526 PMCID: PMC7977646 DOI: 10.3174/ajnr.a0561] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Little is known about the long-term clinical outcomes of sacroplasty, a relatively new minimally invasive percutaneous procedure for the treatment of sacral insufficiency fractures. The first purpose of the present study, therefore, was to investigate the effects of sacroplasty on pain, mobility, and activities of daily living (ADLs). A second purpose was to compare clinical outcomes of sacroplasty with those of vertebroplasty, a similar but more established procedure. MATERIALS AND METHODS A retrospective case series of 12 patients who had a sacroplasty and a control group of 21 patients who had undergone a vertebroplasty was conducted. A 12-item questionnaire and subsequent telephone interview requested each patient to rate the intensity of pain, as well as the ability to ambulate and perform ADLs, before sacroplasty or vertebroplasty, and at the time of the interview. RESULTS There was a statistically significant decrease in overall self-reported pain, as well as an increase in self-reported ability to ambulate and perform ADLs after sacroplasty or vertebroplasty. These improvements were equivalent, regardless of which procedure the patient received. CONCLUSION The present study suggests that the treatment of sacral insufficiency fractures with sacroplasty produces relatively long-lasting improvements in pain, mobility, and the ability to perform ADLs. These data also suggest that the clinical outcomes of sacroplasty are comparable with those of vertebroplasty, an accepted and more routinely performed procedure.
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Affiliation(s)
- C T Whitlow
- Division of Radiologic Sciences, Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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