1
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Noma M, Sato Y, Hara N, Yu J, Fukuhara H, Fukushima M, Nishizawa M, Komatsu N, Oshima Y. Treatment Outcomes of Lower Urinary Tract Symptoms due to Fragility Sacral Fractures: A Review of Eight Patients and Literature. World Neurosurg 2024; 188:e278-e287. [PMID: 38777323 DOI: 10.1016/j.wneu.2024.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Sacral fractures can cause lower urinary tract symptoms (LUTS) due to damage to the cauda equina. While several studies have reported on sacral fractures due to high-energy trauma, those due to fragility fractures have only been reported in case reports and their clinical differences are not well known. This study aimed to investigate the clinical characteristics of LUTS caused by fragility sacral fractures and propose a novel treatment strategy. METHODS This study is retrospective, uncontrolled, clinical case series. The inclusion criteria were sole sacral fractures due to low-energy trauma and appearance of LUTS after injury. Patients with additional spinal fractures or combined abdominal or pelvic organ injuries that could cause LUTS were excluded. Improvement in LUTS, period from onset to improvement, and imaging findings were recorded. RESULTS Eight patients met the inclusion criteria (4 surgical and 4 conservative treatment cases). Six patients showed improvement in LUTS. In surgical cases, the mean period from onset of LUTS to surgery and from onset of LUTS to improvement was 14.5 and 21.5 days, respectively. Intraoperative rupture or laceration of the dural sac was not observed. In 2 conservatively improved cases, the period from onset to improvement of LUTS was 14 and 17 days. CONCLUSIONS LUTS can improve even with conservative treatment and should be utilized as the primary choice. LUTS caused by severe sacral canal deformity and stenosis can be reversible, and the decision to perform surgical treatment is still timely if LUTS do not improve with conservative treatment for several weeks.
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Affiliation(s)
- Michita Noma
- Department of Orthopedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan; Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yusuke Sato
- Department of Orthopedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
| | - Nobuhiro Hara
- Department of Orthopedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Jim Yu
- Department of Orthopedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hiroki Fukuhara
- Faculty of Medicine, Department of Urology, Yamagata University, Yamagata, Japan
| | | | - Mitsuhiro Nishizawa
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Naoto Komatsu
- Department of Orthopedic and Spine Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Yasushi Oshima
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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2
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Tolosano L, Rieussec C, Sauzeat B, Caillard G, Drevet S, Kerschbaumer G, Porcheron G, Wagner D, Rommens PM, Tonetti J, Boudissa M. Fragility fractures of the pelvis: First 48 cases of surgical treatment at a level 1 trauma center in France. Orthop Traumatol Surg Res 2024; 110:103855. [PMID: 38438109 DOI: 10.1016/j.otsr.2024.103855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 06/30/2023] [Accepted: 01/04/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Longer life expectancy is accompanied by a higher incidence of fragility fractures of the pelvis (FFP), which has repercussions on mortality and nursing home admissions. Given the paucity of data at French healthcare facilities, we carried out a retrospective study to (1) evaluate how surgical treatment of FFP with posterior displacement (type III and IV according to Rommens and Hofmann) affects a patient's pain, functional status and ability to stay at home and (2) evaluate the postoperative complications and mortality rate. HYPOTHESIS Surgery for posteriorly displaced FFP will relieve pain and preserve the patient's independence. METHODS All the patients over 65 years of age who were operated on for a posterior FFP between January 2015 and August 2020 were included in this prospective, single-center study. The demographics, fracture type, details of the surgical treatment, complications and mortality were analyzed. Pain (visual analog scale, VAS), functional status (Activity of Daily Living [ADL] and Instrumental Activity of Daily Living [IADL]), mobility (Parker score) and rates of nursing home admissions were compared before the fracture, after surgery and at a mean follow-up of 28 months (minimum follow-up of 1 year). RESULTS Forty-eight patients with a mean age of 75 years were included. Twenty-four of these patients (50%) had at least two comorbidities. The FFPs were either type IV (31/48; 65%) or type III (17/48; 35%). The mean VAS for pain was significantly lower on the first day postoperative (3.5 versus 4.8; p=0.02). This significant reduction continued upon discharge from the hospital (1.95; p=0.003) and persisted at the mean follow-up of 28 months (2.2; p=0.64). The complication rate was 15% (7/48) and the mortality rate at the final review was 15% (7/48). Among the surviving patients, 81% (29/36) returned to living at home. The ADL (5.1 versus 5.8; p=0.09), IADL (5.9 versus 6.9; p=0.15) and Parker score (6.8 versus 8.2; p=0.08) at the final review were not significantly different from the values before the fracture. CONCLUSION This is the first French study of patients operated on for an FPP. Fixation of posteriorly displaced fractures allows surviving patients to retain their mobility. Pain relief is achieved quickly and maintained during the follow-up period. Thus, our initial hypothesis is affirmed. The complication rate is not insignificant; given the complexity of this surgery, percutaneous treatment is preferable. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Luca Tolosano
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France
| | - Clementine Rieussec
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France
| | - Bérengère Sauzeat
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France
| | - Gauthier Caillard
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France
| | - Sabine Drevet
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France
| | - Gael Kerschbaumer
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France
| | - Geoffrey Porcheron
- Orthopedic and Trauma Surgery Department, Mayence University Hospital, Langenbeckstrasse 1, 55131 Mayence, Germany
| | - Daniel Wagner
- Orthopedic and Trauma Surgery Department, Mayence University Hospital, Langenbeckstrasse 1, 55131 Mayence, Germany
| | - Pol Maria Rommens
- Orthopedic and Trauma Surgery Department, Mayence University Hospital, Langenbeckstrasse 1, 55131 Mayence, Germany
| | - Jérôme Tonetti
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France; TIMC-IMAG lab, CNRS UMR 5525, Grenoble Alpes University, 38700 La Tronche, France
| | - Mehdi Boudissa
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France; TIMC-IMAG lab, CNRS UMR 5525, Grenoble Alpes University, 38700 La Tronche, France.
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3
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Singh M, Balmaceno-Criss M, Knebel A, Kuharski M, Sakr I, Daher M, McDonald CL, Diebo BG, Czerwein JK, Daniels AH. Sacroplasty for Sacral Insufficiency Fractures: Narrative Literature Review on Patient Selection, Technical Approaches, and Outcomes. J Clin Med 2024; 13:1101. [PMID: 38398413 PMCID: PMC10889545 DOI: 10.3390/jcm13041101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Sacral insufficiency fractures commonly affect elderly women with osteoporosis and can cause debilitating lower back pain. First line management is often with conservative measures such as early mobilization, multimodal pain management, and osteoporosis management. If non-operative management fails, sacroplasty is a minimally invasive intervention that may be pursued. Candidates for sacroplasty are patients with persistent pain, inability to tolerate immobilization, or patients with low bone mineral density. Before undergoing sacroplasty, patients' bone health should be optimized with pharmacotherapy. Anabolic agents prior to or in conjunction with sacroplasty have been shown to improve patient outcomes. Sacroplasty can be safely performed through a number of techniques: short-axis, long-axis, coaxial, transiliac, interpedicular, and balloon-assisted. The procedure has been demonstrated to rapidly and durably reduce pain and improve mobility, with little risk of complications. This article aims to provide a narrative literature review of sacroplasty including, patient selection and optimization, the various technical approaches, and short and long-term outcomes.
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Affiliation(s)
- Manjot Singh
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Ashley Knebel
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Michael Kuharski
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Itala Sakr
- Department of Orthopedic Surgery, Hotel Dieu de France, Beirut 166830, Lebanon
| | - Mohammad Daher
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Christopher L. McDonald
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Bassel G. Diebo
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - John K. Czerwein
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Alan H. Daniels
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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Arthur RY, Johnson JP. Surgical treatment of sacral nonunions. Injury 2023:S0020-1383(23)00406-0. [PMID: 37179204 DOI: 10.1016/j.injury.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Sacral fractures are complex injuries that follow a bimodal distribution, typically involving acute high energy trauma in young adults and low energy trauma in older adults (> 65 years old). Nonunion is a rare but debilitating potential complication of undiagnosed or improperly managed sacral fractures. Various surgical techniques, including open reduction and internal fixation, sacroplasty, and percutaneous screw fixation, have been used to manage these fracture nonunions. In addition to reviewing the initial management of sacral fractures and the risk factors for fracture nonunion, this article describes techniques, specific cases and outcomes of these treatment strategies.
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Affiliation(s)
- Rodney Y Arthur
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 510 20th St South, Faculty Office Tower 901, Birmingham, AL 35294, USA
| | - Joey P Johnson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 510 20th St South, Faculty Office Tower 901, Birmingham, AL 35294, USA.
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5
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Barber LA, Katsuura Y, Qureshi S. Sacral Fractures: A Review. HSS J 2023; 19:234-246. [PMID: 37065102 PMCID: PMC10090841 DOI: 10.1177/15563316221129607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/05/2022] [Indexed: 04/18/2023]
Abstract
At the cornerstone of the pelvis and spine, the sacrum may be fractured in patients of all ages. Sacral fractures range from high-energy injuries, with mortality rates of up to 18%, to low-energy insufficiency fractures. The intricate geometry of the sacrum, the breadth of morphotypes, and the presence of congenital anomalies all can complicate the treatment of these fractures. Agreement on the surgical indications for these injuries is limited. This narrative review aims to update orthopedic surgeons on the clinical evaluation and the non-surgical and surgical management of these fractures.
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Affiliation(s)
| | | | - Sheeraz Qureshi
- Emory Spine Center, Atlanta, GA, USA
- Department of Orthopaedic Surgery, Hospital
for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
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6
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Putzeys G, Dekeyser T, Garré P, Chesser T, Pottel H. Posterior pelvic ring involvement detected with CT taken within a week of admission in acute fragility fractures of the pelvis (FFP) does not predict failure of conservative treatment: a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:320. [PMID: 37087474 PMCID: PMC10122380 DOI: 10.1186/s12891-023-06439-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/18/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Acute low energy pubic rami fractures in the elderly receive primarily conservative treatment. There is debate to what extent posterior ring involvement, which is detected superiorly by CT compared to X-ray, has an impact on outcome and may require modified treatment. We want to demonstrate if posterior ring involvement has an influence on different types of outcome in primarily conservatively treated acute FFP, questioning the usefulness of early CT. Additionally we analysed the early fracture pattern in cases where conservative treatment failed with need for secondary surgery. METHODS A retrospective cohort study of 155 consecutive patients, recruited between 2009 and 2016, aged over 65 years diagnosed with an acute LE-PFr on X-ray at the emergency department of a single, level-one trauma centre and receiving an early CT. A set of outcome parameters was compared between patients with an isolated pubic rami fracture (CTia) and patients who had a combined posterior pelvic ring fracture (CTcp). RESULTS There were 155 patients of whom 85.2% were female with a mean age of 83 years. 76.8% of patients living at home returned home and 15.5% moved to a nursing home. Mortality rate during hospitalisation was 6.4% and 14.8% at one year post-trauma. Secondary fracture displacement occurred in 22.6%. Secondary surgery was performed in 6 cases (3.9%). Median hospitalisation length of stay was 21 days (range 0 to 112 days). There was no significant association between the subgroups and change in residential status (p = 0.65), complications during hospitalisation (p = 0.75), mortality rate during admission (p = 0.75) and at 1 year (p = 0.88), readmission within 30 days (p = 0.46) and need for secondary surgery (p = 0.2). There was a significant increased median length of stay (p = 0.011) and rate of secondary displacement (p = 0.015) in subgroup CTcp. Secondary displacement had no impact on in-hospital complications (p = 0.7) nor mortality rate during admission (p = 0.79) or at 1 year (0.77). Early CT in patients who underwent secondary surgery showed stable B2.1 lesions in 4 of 6 cases. CONCLUSIONS Our data suggest that early CT in patients with conservatively treated acute LE-PFr in order to detect posterior lesions, has limited value in predicting failure of conservative treatment.
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Affiliation(s)
- Guy Putzeys
- Orthopedic and Trauma Department, AZ Groeninge hospital, Kortrijk, Belgium.
| | | | - Patrick Garré
- Department of data management, AZ Groeninge hospital, Kortrijk, Belgium
| | | | - Hans Pottel
- Department of Public Health and Primary Care, KULeuven KULAK, Kortrijk, Belgium
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7
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Jurik AG. Diagnostics of Sacroiliac Joint Differentials to Axial Spondyloarthritis Changes by Magnetic Resonance Imaging. J Clin Med 2023; 12:jcm12031039. [PMID: 36769687 PMCID: PMC9917960 DOI: 10.3390/jcm12031039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
The diagnosis of axial spondyloarthritis (axSpA) is usually based on a pattern of imaging and clinical findings due to the lack of diagnostic criteria. The increasing use of magnetic resonance imaging (MRI) of the sacroiliac joints (SIJ) to establish the diagnosis early in the pre-radiographic phase has resulted in a shift in the paradigm with an increasing frequency of axSpA diagnoses and a changed sex distribution. Non-radiographic axSpA affects males and females nearly equally, whereas ankylosing spondylitis predominantly occurs in males. The MRI-based increasing frequency of axSpA in women is mainly due to the presence of subchondral bone marrow edema (BME) on fluid-sensitive MR sequences, which may be a non-specific finding in both women and men. Due to the somewhat different pelvic tilt and SIJ anatomy, women are more prone than men to develop strain-related MRI changes and may have pregnancy-related changes. Awareness of non-specific subchondral BME at the SIJ is important as it can imply a risk for an incorrect SpA diagnosis, especially as the clinical manifestations of axSpA may also be non-specific. Knowledge of relevant MRI and clinical features of differential diagnoses is needed in the diagnostic workout of patients with suspected axSpA considering that non-SpA-related SIJ conditions are more common in patients with low back or buttock pain than axSpA sacroiliitis. The purpose of this review was to present current knowledge of the most frequent differential diagnoses to axSpA sacroiliitis by MRI taking the clinical characteristics into account.
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Affiliation(s)
- Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
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8
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Resource Consumption and Remuneration Aspects in Navigated Screw Fixation Procedures with or without Additional Sacroplasty for Fragility Fractures of the Sacrum-A Prospective Clinical Study. J Clin Med 2022; 11:jcm11206136. [PMID: 36294455 PMCID: PMC9605172 DOI: 10.3390/jcm11206136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Surgical treatment for sacral fragility fractures using navigation-assisted screw fixation (NSF) is a modern, technically demanding procedure. Additional sacroplasty (ASP) has been shown to provide only insignificant clinical benefits for patients. This investigation highlights procedural economic aspects and evaluates results with regard to resource scarcity in order to be able to decide, whether ASP has a justification in NSF procedures beyond clinical aspects. From February 2011 to May 2017, all individuals with sacral fragility fractures surgically treated using 3D-fluoroscopy for NSF (n = 26) or NSF + ASP (n = 26) were enrolled. Outcome parameters were operative time, 3D-/2D-radiation dose, 2D-fluoroscopy time, material costs and reimbursement. In the two groups, a total of 52 individuals with 124 fragility fracture sites in sacral vertebrae I and II were surgically treated with similar numbers of screws inserted (p ≈ 0.679) requiring similar 3D- (p ≈ 0.546) and 2D-fluoroscopy radiation doses (p ≈ 0.236). In procedures with ASP, average 2D-fluoroscopy time (46.6 s vs. 32.7 s, p ≈ 0.004), and mean surgical duration (119 min vs. 96 min, p ≈ 0.011) were significantly longer. Mean implant costs (EUR 668.68 vs. EUR 204.34, p < 0.001), and reimbursement (EUR 8416.01 vs. EUR 6584.49, p ≈ 0.006) were significantly higher. Although comparison of costs and reimbursements indicated a positive financial balance, profitability was not confirmed, because financial expense for extended operative time prevented an economic advantage of procedures with ASP in this investigation. A formula was developed based on presented study data to allow similar economical decisions in other health care systems or institutions with differing resource costs.
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9
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Cattaneo S, Adriani M, Tonolini S, Oransky M, Galante C, Grava G, Milano G, Casiraghi A. FRAGILITY FRACTURES OF THE SACRUM: A SILENT EPIDEMIC. Orthop Rev (Pavia) 2022; 14:38572. [DOI: 10.52965/001c.38572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Fragility fractures of the sacrum (FFS) are caused by low-energy trauma in the elderly population. Due to the nuanced symptomatology, many FFS remains unrecognized and the prevalence is underestimated. The clinical presentation varies, typically presenting with weightbearing low back pain without even remembering of a previous trauma. Radiographs are usually insufficient for the diagnosis and second level imaging modalities are required. In particular, magnetic resonance demonstrated the highest diagnostic accuracy. Treatment should aim to guarantee early mobilization and weightbearing, efficient pain relief and early discharge from the hospital to a proper facility for rehabilitation. Conservative treatment is reserved to non-displaced fractures with an adequate pain relief within one week allowing early mobilization. Otherwise, surgical treatment must be preferred. Nowadays, minimally invasive techniques, such as ileo-sacral screws or trans-sacral bar osteosynthesis, are safe and effective procedures and have overcome open procedures. In more complex patterns, with complete dissociation between the pelvic ring and the ilio-lumbar spine, spino-pelvic fixation is the procedure of choice.
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Affiliation(s)
| | | | | | | | | | | | - Giuseppe Milano
- Department of Bone and Joint Surgery, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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10
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Cantrell CK, Butler BA. A Review on Management of Insufficiency Fractures of the Pelvis and Acetabulum. Orthop Clin North Am 2022; 53:431-443. [PMID: 36208886 DOI: 10.1016/j.ocl.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
"Insufficiency fractures of the pelvis and acetabulum are occurring at increasing rates. Osteoporosis is the most prevalent risk fracture. Diagnosis begins with plain radiographs followed by advanced imaging with computed tomography and/or MRI. Pelvic ring fragility injuries are classified by the Fragility fractures of the pelvis system. Elderly acetabular fractures may be classified by the Letournel system. Management of these injuries is primarily nonoperative with early immobilization when allowed by fracture characteristics. When warranted, percutaneous fixation and open reduction internal fixation are options for both. Both acute and delayed total hip arthroplasty are options for acetabular fractures."
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Affiliation(s)
- Colin K Cantrell
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 1350, Chicago, IL 60611, USA.
| | - Bennet A Butler
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 1350, Chicago, IL 60611, USA
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11
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Garg B, Mehta N. Acute Neurological Deficit Due to Sacral Insufficiency Fracture With Coexistent Severe Lumbar Canal Stenosis: A Case Report. HSS J 2022; 18:307-311. [PMID: 35645643 PMCID: PMC9097004 DOI: 10.1177/15563316211006665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India
Institute of Medical Sciences, New Delhi, India
| | - Nishank Mehta
- Department of Orthopaedics, Jai Prakash
Narayan Apex Trauma Center, New Delhi, India,Nishank Mehta, MS, Department of Orthopaedics, Jai
Prakash Narayan Apex Trauma Center, New Delhi 110029, India.
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12
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Wu J, Lakomy DS, Fellman BM, Salcedo MP, Sood AK, Jhingran A, Klopp AH, Iyer RB, Jimenez C, Colbert LE, Eifel PJ, Schmeler KM, Lin LL. Longitudinal Changes in Bone Mineral Measurements Inside and Outside Radiation Fields Used for Cervical Cancer Treatment. Pract Radiat Oncol 2022; 12:e423-e433. [PMID: 35390531 DOI: 10.1016/j.prro.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/18/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE We compared the magnitude of changes in bone mineral density (BMD), within and outside the radiation field, among women who received pelvic radiotherapy (RT) with or without chemotherapy for cervical cancer. PATIENTS & METHODS In this secondary analysis of a prospective study, we analyzed serial CT scans and dual-energy X-ray absorptiometry (DXA) scans from 78 patients who received definitive RT or chemoradiation (CRT) for cervical cancer at a single institution from 2008 to 2015. BMD values at L1, L2, L3 and L4 were measured. We compared changes in BMD within the radiation field (i.e., at L4) with those outside the field (i.e., at L1). Linear mixed models were also used to examine the effect of RT on changes in BMD over time and covariate adjustment. RESULTS The median age of the 78 patients was 45.5 years (range 23-88); all received RT and 76 (97%) received concurrent CRT. Treatment was associated with significant declines in BMD in all 4 lumbar vertebral bodies over time (P<0.05), with nadir at 3 months for L4 and at 1 year for L1. Pairwise comparisons at 3 months and 2 years after treatment indicated that BMD in L4 (within the RT field) had improved (P=0.037), but BMD in L1 (outside the RT field) was no different at 3 months and 2 years. CONCLUSIONS Significant BMD declines were observed in all lumbar vertebral bodies immediately following RT. However, in-field vertebral bodies reached nadir BMD earlier than those located outside the RT field. Our results suggest that treatment and patient-related factors other than RT may contribute to declines in BMD after treatment for cervical cancer. Routine bone density screening and post-RT therapy with hormones may be beneficial for selected patients who receive CRT for cervical cancer.
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Affiliation(s)
- Juliana Wu
- University of Texas Medical Branch, Galveston, TX; Departments of Radiation Oncology, Houston, TX
| | - David S Lakomy
- Departments of Radiation Oncology, Houston, TX; Dartmouth Geisel School of Medicine, Hanover, NH
| | | | - Mila P Salcedo
- Departments of Gynecologic Oncology and Reproductive Medicine, Houston, TX; Obstetrics and Gynecology Department, Federal University of Health Sciences/Irmandade Santa Casa de Misericordia, Porto Alegre, Brazil
| | - Anil K Sood
- Departments of Gynecologic Oncology and Reproductive Medicine, Houston, TX
| | | | - Ann H Klopp
- Departments of Radiation Oncology, Houston, TX
| | | | - Camilo Jimenez
- Departments of Endocrinology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Lilie L Lin
- Departments of Radiation Oncology, Houston, TX.
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13
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Nuber S, Ritter B, Fenwick A, Förch S, Wanzl M, Nuber M, Mayr E. Midterm follow-up of elderly patients with fragility fractures of the pelvis: A prospective cohort-study comparing operative and non-operative treatment according to a therapeutic algorithm. Injury 2022; 53:496-505. [PMID: 34629169 DOI: 10.1016/j.injury.2021.09.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/20/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The treatment of fragility fractures of the pelvis (FFP) is a challenge. The variations of non-operative- and of operative treatment are manifold and a structured treatment algorithm is lacking. The purpose of this study was to evaluate the outcome of elderly patients with a FFP who were treated with a therapeutic algorithm based on the FFP-classification. PATIENTS AND METHODS In a prospective cohort study 154 patients (mean age: 81.8 ±.61 (65-96); female: (86.8%; 131/154). BMI: 23.7 ±.34 (15-43)) with a FFP after inadequate mono trauma were treated according to a strict therapeutic algorithm between 04/2016 and 12/2018. According to a classification based on CT-scans either a standardized operative treatment or conservative therapy was induced and the outcome regarding objective measurements of mobility, pain, need for analgesics and mortality during hospital stay and after one year was analyzed. RESULTS 82/154 participants (53.2%) were assigned to the conservative treatment group and 72 participants (46.8%) to the operative treatment group. The overall one-year survival rate was 78.1% (118/151). The survival of the operative treatment group was 90.7% (49/54) and significantly higher than the survival of the conservative treatment group (74.7%; 56/75; p=.023). The one-year follow up showed a high dispersion of the pain level in the operatively treated patients and a significantly higher mean in comparison to conservatively treated patients. Both treatment groups showed increasing numbers of patients with unlimited mobilization but also immobile patients. Overall in 31.0% (18/58) of the operative participants and in 14.9% (14/93) of the non-operatively treated participants complications occurred (p=.04). CONCLUSION The strict compliance to the presented treatment algorithm of FFP with an operative strategy starting from FFP IIc leads to a significantly lower mortality within one year in comparison to the conservatively treated patients. The worst outcome and the highest mortality was seen in patients who refused the recommendation of operative stabilization. The results of this study justify to proceed with the strict classification dependent treatment algorithm and also support the early switch-over to operative treatment of patients with failed conservative therapy in FFP I to FFP IIb.
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Affiliation(s)
- Stefan Nuber
- Department of Trauma, Orthopedics, Plastic and Hand Surgery, University Medicine, Stenglinstraße 2, D-86156 Augsburg, Germany.
| | - Benedikt Ritter
- Department of Trauma, Orthopedics, Plastic and Hand Surgery, University Medicine, Stenglinstraße 2, D-86156 Augsburg, Germany
| | - Annabel Fenwick
- Department of Trauma, Orthopedics, Plastic and Hand Surgery, University Medicine, Stenglinstraße 2, D-86156 Augsburg, Germany
| | - Stefan Förch
- Department of Trauma, Orthopedics, Plastic and Hand Surgery, University Medicine, Stenglinstraße 2, D-86156 Augsburg, Germany
| | - Maximilian Wanzl
- Department of Trauma, Orthopedics, Plastic and Hand Surgery, University Medicine, Stenglinstraße 2, D-86156 Augsburg, Germany
| | - Monika Nuber
- Department of Trauma, Orthopedics, Plastic and Hand Surgery, University Medicine, Stenglinstraße 2, D-86156 Augsburg, Germany
| | - Edgar Mayr
- Department of Trauma, Orthopedics, Plastic and Hand Surgery, University Medicine, Stenglinstraße 2, D-86156 Augsburg, Germany
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Increase in Osteoporotic U-Type Sacral Fractures: Role of the Transiliac-Transsacral Screw Versus Lumbopelvic Fixation. J Orthop Trauma 2021; 35:S21-S25. [PMID: 34533498 DOI: 10.1097/bot.0000000000002229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 02/02/2023]
Abstract
As the population is increasing in age, so increases the number of osteoporotic fractures. U-shaped sacral fractures can be difficult to diagnose and may be a source of disability in patients when left untreated. Many patients with osteoporotic fractures are of advanced age and may experience rapid medical decline when these fractures cause immobility. We present surgical options for U-shaped sacral fracture management.
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15
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Sabaliauskas V, Tiškevičius S. Diagnosing sacral insufficiency fractures after radiotherapy in women with cervical cancer: Report of three cases. Radiol Case Rep 2021; 16:2938-2944. [PMID: 34401030 PMCID: PMC8350190 DOI: 10.1016/j.radcr.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Diagnosing sacral insufficiency fractures (SIF) in oncology patients is a challenge to radiologists, and recognition of imaging features is essential in order to avoid misdiagnosis of bone metastases and prevent patients from inaccurate treatment. Clinical cases in order to better understand the essence of this pathology and to make diagnosis easier, we present three clinical cases of SIF in patients with cervical cancer. All patients received radiation therapy (external beam radiation and brachytherapy) and chemotherapy with cisplatin. Patients underwent pelvic MRI, CT, SPECT or SPECT/CT examinations. One patient underwent a FDG-PET/CT examination. Conclusions SPECT/CT should be included in the differential diagnostics when radiological features of pelvic bone pathology on CT or MRI are undetermined or SIF are suspected. SIF must always be considered in oncology patients with pelvic pain, especially in postmenopausal state and after radiation therapy. For patients with osteoporosis, bone density screening and precise review of the most common fracture sites are recommended.
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16
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Gierig M, Liu F, Weiser L, Lehmann W, Wriggers P, Marino M, Saul D. Biomechanical Effects of a Cross Connector in Sacral Fractures - A Finite Element Analysis. Front Bioeng Biotechnol 2021; 9:669321. [PMID: 34124023 PMCID: PMC8188498 DOI: 10.3389/fbioe.2021.669321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model). Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration. Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated (p < 0.0001). Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant.
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Affiliation(s)
- Meike Gierig
- Institute of Continuum Mechanics, Leibniz University Hannover, Hanover, Germany
| | - Fangrui Liu
- Institute of Continuum Mechanics, Leibniz University Hannover, Hanover, Germany
| | - Lukas Weiser
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, Göttingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, Göttingen, Germany
| | - Peter Wriggers
- Institute of Continuum Mechanics, Leibniz University Hannover, Hanover, Germany
| | - Michele Marino
- Department of Civil Engineering and Computer Science, University of Rome Tor Vergata, Rome, Italy
| | - Dominik Saul
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, Göttingen, Germany.,Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN, United States
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17
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Seo JY, Ha KY, Kim YH, Park HY, Chang DG, Choi YH, Rho YH, Kim SI. Analysis of Fracture Patterns and Characteristics in Sacral Insufficiency Fracture: Do Sacral Fractures Occur in Patients Who Had Previous Lumbosacral Fusion Insufficiency Fractures or Stress Fractures? Asian Spine J 2021; 15:769-777. [PMID: 33915616 PMCID: PMC8696056 DOI: 10.31616/asj.2020.0466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/08/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design This study is a retrospective analysis of a case. Purpose The purpose of this study is to investigate the fracture patterns and risk factors of sacral insufficiency fractures (SIFs) to improve their diagnosis in clinical practice. Overview of Literature SIFs occur when normal stresses are applied to a bone with decreased density, most often due to osteoporosis. Individuals who receive lumbosacral fusion procedures may also suffer from increased incidents of SIFs because of decreased bone density related to aging. Methods In total, 55 patients with SIFs were retrospectively investigated in this study. The study population was divided into lumbosacral fusion (n=20) and non-fusion (n=35) groups. Subsequently, the patients' demographic characteristics, comorbidities, medication history, results of diagnostic imaging studies, and bone mineral density were assessed. The fracture patterns were classified either according to the five typical types (H-pattern bilateral vertical plus horizontal component, unilateral vertical only, bilateral vertical only, unilateral vertical plus horizontal component, and horizontal only fracture) or atypical types. Results In total, 44 of 55 patients (80%) suffered from more than one senile disease and received corresponding medications that caused secondary osteoporosis. A total of 12 patients had S1 lumbosacral fixation. Moreover, three of these 12 patients who developed a SIF immediately after a lumbosacral fracture had an unstable sacral U fracture. The remaining nine patients showed fracture patterns similar to the non-fusion patients. Single-photon emission computed tomography (SPECT)/computed tomography (CT) can identify fracture recurrence in previously healed fractures. In total, 24 patients (43.6%) had fractures of the pelvis, femur, and thoracolumbar spine. Conclusions SIF develops in elderly patients with multiple adult diseases that can induce secondary osteoporosis. Such fractures may occur in the patients with instrumented lumbosacral fusion. Importantly, some patients showed stress fractures after multilevel instrumented lumbosacral fusion, whereas others showed insufficiency fractures. The different fracture patterns correspond to different grades of SIF, and SPECT/CT can easily identify the fracture status.
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Affiliation(s)
- Jun-Yeong Seo
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.,St. Mary's Goodheal Orthopaedics, Seoul, Korea
| | - Kee-Yong Ha
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Young-Hoon Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung-Youl Park
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Yong-Hwan Choi
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Young-Ho Rho
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Sang-Il Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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18
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Abernathy BR, Schroder LK, Bohn DC, Switzer JA. Low-Energy Pelvic Ring Fractures: A Care Conundrum. Geriatr Orthop Surg Rehabil 2021; 12:2151459320985406. [PMID: 33643677 PMCID: PMC7890705 DOI: 10.1177/2151459320985406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/05/2020] [Accepted: 12/02/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction: A need exists for improved care pathways for patients experiencing low-energy pelvic ring fractures. A review of the current literature was performed to understand the typical patient care and post-acute rehabilitation pathway within the US healthcare system. We also sought to summarize reported clinical outcomes worldwide. Significance: Low-energy pelvic ring fracture patients usually do not qualify for inpatient admission, yet they often require post-acute rehabilitative care. The Center for Medicare and Medicaid Services’ (CMS) 3-day rule is a barrier to obtaining financial coverage of this rehabilitative care. Results: Direct admission of some patients to post-acute care facilities has shown promise with decreased cost, improved patient outcomes, and increased patient satisfaction. Secondary fracture prevention programs may also improve outcomes for this patient population. Conclusions: Post-acute care innovation and secondary fracture prevention should be prioritized in the low-energy pelvic fragility fracture patient population. To demonstrate the effect and feasibility of these improved care pathways, further studies are necessary.
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Affiliation(s)
| | - Lisa K Schroder
- Department of Orthopedics, University of Minnesota, Minneapolis, MN, USA.,HealthPartners, Bloomington, MN, USA
| | - Deborah C Bohn
- Department of Orthopedics, University of Minnesota, Minneapolis, MN, USA.,TRIA Orthopedics, Bloomington, MN, USA
| | - Julie A Switzer
- Department of Orthopedics, University of Minnesota, Minneapolis, MN, USA.,HealthPartners, Bloomington, MN, USA.,Park Nicollet Methodist Hospital, St Louis Park, MN, USA
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19
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Bovbjerg P, Høgh D, Froberg L, Schmal H, Kassem M. Effect of PTH treatment on bone healing in insufficiency fractures of the pelvis: a systematic review. EFORT Open Rev 2021; 6:9-14. [PMID: 33532082 PMCID: PMC7845562 DOI: 10.1302/2058-5241.6.200029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The aging of our society is associated with an increasing number of insufficiency fractures of the pelvis and the current standard of care is pain control and early mobilization. The aim of this study was to explore whether parathyroid hormone (PTH) treatment can support bone healing in these patients. We conducted a systematic review searching the databases PubMed, Embase and Cochrane. Our primary outcome was fracture healing, secondary outcome measures comprised pain, mobility and patient-reported outcome measures (PROMs). Eight articles were included in the qualitative synthesis, of which two were included in a meta-analysis. However, only three studies were comparative including one randomized controlled trial. Fracture healing and reported pain were assessed after eight weeks, and were significantly improved in the group being treated with PTH (p < 0.01) in the meta-analysis. All articles described a positive effect for PTH on fracture healing and pain. Our systematic review indicates that there is a positive effect of PTH treatment on healing and pain in patients with insufficiency fracture in the pelvic ring, but further research is necessary.
Cite this article: EFORT Open Rev 2021;6:9-14. DOI: 10.1302/2058-5241.6.200029
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Affiliation(s)
- Pernille Bovbjerg
- Department of Orthopedic Surgery, Odense University Hospital, Odense, Denmark
| | - Ditte Høgh
- Department of Orthopedic Surgery, Hospital of Southern Denmark, Odense, Denmark
| | - Lonnie Froberg
- Department of Orthopedic Surgery, Odense University Hospital, Odense, Denmark
| | - Hagen Schmal
- Department of Orthopedic Surgery, Odense University Hospital, Odense, Denmark.,Clinic of Orthopaedic Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Moustapha Kassem
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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20
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Andresen JR, Prokop A, Wollny M, Radmer S, Schober HC, Andresen R. [Clinical outcome and revenue situation after conservative, interventional and surgical/osteosynthetic treatment of sacral insufficiency fractures]. Unfallchirurg 2020; 124:588-597. [PMID: 33301083 DOI: 10.1007/s00113-020-00932-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Insufficiency fractures of the sacrum are being detected increasingly more frequently, whereby their incidence will no doubt increase further as a result of the rise in life expectancy. OBJECTIVE The clinical appearance of sacral insufficiency fractures, the treatment approach taking into account the clinical outcomes and the DRG proceeds are discussed on the basis of clinical examples. PATIENTS AND METHODS Three female patients (average age 78.3 years) with sacral insufficiency fractures were admitted for inpatient treatment due to increasing disabling pain. Taking into account the clinical symptoms and the recommendation of an interdisciplinary case conference, one patient was treated conservatively with short-term bed rest, accompanying analgesic medication and pain-adapted exercise measures. The second patient underwent computed tomography (CT)-guided balloon sacroplasty. Transsacroiliac screw fixation was performed on the third patient. Pain was documented over the course on a visual analogue scale (VAS) and the degree of independence on the Barthel scale. The fractures were classified according to Denis et al. and the classification of the FFP according to Rommens and Hofmann. The DRG revenue for the 2020 accounting period was then presented for each case. RESULTS Patient No. 1: conservative therapy, unilateral Denis 1 fracture zone, corresponding to an FFP type IIa, baseline pain 7 score points, at discharge 4 score points, the Barthel scale increased from 55 to 75 points. After 6 days hospitalization, transferred to rehab. The DRG proceeds were € 3817.95. Patient No. 2: balloon sacroplasty, bilateral Denis 1-2 fracture zone, corresponding to an FFP type IIa, baseline pain 9 score points, at discharge 2 score points, the Barthel scale increased from 35 to 95 points. After 4 days hospitalization, discharged to outpatient follow-up treatment. The DRG proceeds were € 7409.44. Patient No. 3: osteosynthesis, bilateral Denis 1 fracture zone, corresponding to an FFP type IIa, baseline pain 7 score points, at discharge 2 score points, the Barthel scale increased from 40 to 90 points. After 5 days hospitalization, transferred to rehab. The DRG proceeds were € 6714.30. CONCLUSION The sacral insufficiency fracture is a strong indicator for the presence of manifest osteoporosis. Fracture risk factors are the female sex, advanced age, the presence of osteoporosis and vitamin D deficiency. Conservative therapy is the first step of the treatment cascade; however, in patients with persistent, disabling pain and no potential for mobilization, sacroplasty or osteosynthesis should be performed at an early stage. In patients treated with coordinated therapy processes and without clinical complications, all three treatment options are economically sufficient.
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Affiliation(s)
- Julian Ramin Andresen
- Fakultät für Medizin, Sigmund-Freud-Privatuniversität, Freudplatz 3, 1020, Wien, Österreich.
| | - Axel Prokop
- Klinik für Unfallchirurgie, Klinikum Sindelfingen-Böblingen, Akademisches Lehrkrankenhaus der Universität Tübingen, Sindelfingen, Deutschland
| | | | - Sebastian Radmer
- Zentrum für Bewegungsheilkunde, Facharztpraxis für Orthopädie, Berlin, Deutschland
| | - Hans-Christof Schober
- Klinik für Innere Medizin IV, Klinikum Südstadt Rostock, Akademisches Lehrkrankenhaus der Universität Rostock, Rostock, Deutschland
| | - Reimer Andresen
- Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Westküstenklinikum Heide, Akademisches Lehrkrankenhaus der Universitäten Kiel, Lübeck und Hamburg, Heide, Deutschland
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21
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Lim EJ, Kim JJ, Kim JW, Kim KH. What characteristics indicate concomitant posterior pelvic injury in pubic ramus fractures in the elderly? Orthop Traumatol Surg Res 2020; 106:849-853. [PMID: 32371015 DOI: 10.1016/j.otsr.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 01/02/2020] [Accepted: 01/28/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Posterior pelvic ring injury (PPRI) can be challenging to diagnose and visualize using plain radiographs; sometimes, PPRI is even overlooked. This study aimed to investigate differences between isolated pubic ramus fractures and fractures concomitant with PPRI in elderly patients. HYPOTHESIS Elderly patients with pubic ramus fractures and concomitant PPRI present different characteristics than patients with isolated ramus fractures. PATIENTS AND METHODS We retrospectively reviewed data of 65 patients aged≥65 who visited the emergency department with a pubic ramus fracture on plain radiograph between January 2013 and December 2018. Patients were divided into two groups based on whether PPRI was found by computed tomography (CT). We then compared patient data and fracture characteristics between the two groups, including displacement and location of the pubic ramus fracture and presence of complete anterior pelvic ring disruption (i.e., concurrent superior and inferior rami fracture). RESULTS PPRI was identified in 49 of 65 patients (75%) on CT. There was greater displacement of the pubic ramus fracture in patients with concomitant PPRI than in those with isolated pubic ramus fractures (4.6mm and 2.2mm, respectively, p<0.001). PPRI more commonly accompanied ramus fractures located medially to the obturator foramen than ramus fractures located in the obturator foramen or laterally to the obturator foramen (96%, 52%, and 77%, respectively, p=0.001). Complete anterior pelvic ring disruption was associated with significantly more concomitant PPRI relative to incomplete anterior pelvic ring disruption (84% and 22%, respectively, p<0.001). DISCUSSION When a pubic ramus fracture is markedly displaced, located medially to the obturator foramen and complete anterior pelvic ring disruption, care should be taken to assess PPRI. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Eic Ju Lim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu Seoul, Republic of Korea
| | - Jung Jae Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu Seoul, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu Seoul, Republic of Korea
| | - Keong-Hwan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu Seoul, Republic of Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon-Si Gangwon-Do, Republic of Korea.
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22
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Abstract
PURPOSE OF REVIEW Axial spondyloarthritis (AxSpA) is a distinct clinical entity with characteristic clinical and radiographic features; however, a multitude of other metabolic, infectious and inflammatory disorders mimic it both clinically and radiographically. RECENT FINDINGS We present in this review article recent updates about the various disease entities and conditions that may mimic AxSpA and how to differentiate among them. The sensitivity and specificity of MRI in diagnosing AxSpA has limitations and needs to be interpreted in the context of the clinical picture. Interestingly, some recent studies have highlighted that a relatively high prevalence of bone marrow edema on pelvic MRIs in healthy volunteers which could even be categorized as having a 'positive MRI' as defined by Assessment of Spondyloarthritis International Society. Another study revealed that a substantial proportion of patients with suspected sacroiliitis were more commonly diagnosed with diseases other than inflammatory sacroiliitis. On the basis of these reports, it is prudent to request MRIs in the appropriate clinical context and interpreted with caution taking into considerations the wide differential diagnosis of such MRI changes. SUMMARY Highlighting the clinical pearls that differentiate disorders suspected of having sacroiliitis will lead to earlier and correct diagnosis and management; however, one must always take into considerations the radiographic and MRI findings in addition to the clinical presentations in order to make the appropriate diagnosis.
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23
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Thiesen DM, Ntalos D, Berger-Groch J, Petersik A, Hofstätter B, Frosch KH, Hartel MJ. The three-dimensional bone mass distribution of the posterior pelvic ring and its key role in transsacral screw placement. Sci Rep 2020; 10:5690. [PMID: 32231222 PMCID: PMC7105496 DOI: 10.1038/s41598-020-61954-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/14/2020] [Indexed: 01/22/2023] Open
Abstract
To optimize the placement of iliosacral screws in osteoporotic bone it is essential to know where to find the best purchase. The aim of this study was to determine and visualize the distribution of bone mass in the posterior pelvic ring by using a color-coded thermal map, to differentiate the bone distribution patterns in normal pelvises and in pelvises with impaired bone density and to identify zones in S1 and S2 with particularly good bone quality, in both healthy and osteoporotic pelvises. A total of 324 pelvises were included. The bone density of the posterior pelvic ring, the fifth lumbar vertebral body (L5) and screw corridors S1 and S2 were visualized. Each individual pelvis was measured with a 3D automated program. Two groups were selected - patients with mean bone density in L5 of ≤100 HU (group 1, n = 52) and those with mean bone density >100 HU (group 2, n = 272). Color-coded thermal maps are presented of the bone density distribution in the pelvises. Bone density in L5 correlated significantly with S1 and S2; bone density was significantly higher in the S1 than in the S2 corridor (p < 0.001). Bone was denser in the posterior and upper parts of the S1 body. Bone density was significantly lower in group 2 than in group 1 (p < 0.001). The color-coded “thermal” maps of bone mass distribution can help surgeons to decide where sacroiliac screws are likely to find optimal purchase.
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Affiliation(s)
- Darius M Thiesen
- Department of Trauma- and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Dimitris Ntalos
- Department of Trauma- and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Josephine Berger-Groch
- Department of Trauma- and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | | | | | - Karl-Heinz Frosch
- Department of Trauma- and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Maximilian J Hartel
- Department of Trauma- and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Chandra V, Wajswol E, Shukla P, Contractor S, Kumar A. Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2019; 30:1845-1854. [PMID: 31587952 DOI: 10.1016/j.jvir.2019.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of sacroplasty for the treatment of osteoporotic and malignant sacral fractures by performing a systematic review and meta-analysis of existing literature. MATERIALS AND METHODS PubMed, Web of Science, and SCOPUS databases were searched from their inception until February 2018 for articles describing sacroplasty. Inclusion criteria were as follows: studies reporting > 5 patients, and pain assessment before and after the procedure recorded with visual analog scale (VAS). Demographic data, procedural details, technical success rates, VAS scores before and after the procedure, and procedural complications were recorded. A random-effects meta-analyses of the VAS pain score before the procedure, at 24-48 hours, at 6 months, and at 12 months were calculated. RESULTS Nineteen studies (18 case series and 1 cohort study) were identified consisting of 861 total patients (682 women and 167 men; mean age 73.89 ± 9.73 years). Patients underwent sacroplasty for the following indications: sacral insufficiency fractures secondary to osteoporosis (n = 664), malignancy (n = 167), and nonspecified sacral insufficiency fractures (n = 30). Technical and clinical successes were achieved in 98.9% (852/861) and 95.7% (623/651) of patients undergoing sacroplasty, respectively. The pooled major complication rate was 0.3%, with 3 patients requiring surgical decompression for cement leakage. Random-effects meta-analyses demonstrated statistically significant differences in the VAS pain level at preprocedure, 24-48 hours, 6 months, and 12 months, with cumulative pain scores of 8.32 ± 0.01, 3.55 ± 0.01, 1.48 ± 0.01, and 0.923 ± 0.01, respectively. CONCLUSIONS Sacroplasty appears safe and effective for pain relief in patients with osteoporotic or malignant sacral fractures, with statistically significant sustained improvement in VAS pain scores up to 12 months.
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Affiliation(s)
- Vishnu Chandra
- Department of Radiology, Rutgers New Jersey Medical School, MSB Room F-506, 185 South Orange Avenue, Newark, NJ 07102
| | - Ethan Wajswol
- Department of Radiology, Rutgers New Jersey Medical School, MSB Room F-506, 185 South Orange Avenue, Newark, NJ 07102
| | - Pratik Shukla
- Department of Radiology, Rutgers New Jersey Medical School, MSB Room F-506, 185 South Orange Avenue, Newark, NJ 07102
| | - Sohail Contractor
- Department of Radiology, Rutgers New Jersey Medical School, MSB Room F-506, 185 South Orange Avenue, Newark, NJ 07102
| | - Abhishek Kumar
- Department of Radiology, Rutgers New Jersey Medical School, MSB Room F-506, 185 South Orange Avenue, Newark, NJ 07102.
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Yang SC, Tsai TT, Chen HS, Fang CJ, Kao YH, Tu YK. Comparison of sacroplasty with or without balloon assistance for the treatment of sacral insufficiency fractures. J Orthop Surg (Hong Kong) 2019; 26:2309499018782575. [PMID: 29923450 DOI: 10.1177/2309499018782575] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Sacral insufficiency fractures (SIFs) can cause severe lower back pain and immobility, which have limited therapeutic options. No previous studies have compared clinical outcomes and radiographic findings of sacroplasty with or without balloon assistance for the treatment of SIFs. METHODS Forty-five patients with SIFs were divided into two groups. One group had 18 patients treated using sacroplasty with balloon assistance, and the other had 27 patients treated without balloon assistance. The operation time and cement injection volume were compared between these two groups. Clinical outcomes were evaluated using visual analog scale (VAS), Oswestry Disability Index (ODI), and Odom's criteria. Cement leakage rate was examined by postoperative radiography and computed tomography. RESULTS Sacroplasty with balloon assistance was associated with significantly longer operative time ( p = 0.003) and larger cement injection volume ( p = 0.038). Cement leakages were found in 4 of 18 patients (22.2%) with balloon assistance and 15 of 27 patients (55.6%) without balloon assistance, which showed significant difference ( p = 0.027). No significant differences were observed between sacroplasty with and without balloon assistance with regard to clinical outcomes including improvement in VAS, ODI, and Odom's criteria. CONCLUSIONS Sacroplasty with balloon assistance was shown to achieve greater cement injection with longer operation time and can decrease the risk of cement leakage. Both sacroplasty with and without balloon assistance showed good-to-excellent clinical outcomes for the treatment of SIFs.
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Affiliation(s)
- Shih-Chieh Yang
- 1 Department of Orthopedic Surgery, I-Shou University, Kaohsiung, Taiwan
| | - Tsung-Ting Tsai
- 2 Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Shu Chen
- 1 Department of Orthopedic Surgery, I-Shou University, Kaohsiung, Taiwan
| | - Chi-Jung Fang
- 1 Department of Orthopedic Surgery, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Hsien Kao
- 1 Department of Orthopedic Surgery, I-Shou University, Kaohsiung, Taiwan
| | - Yuan-Kun Tu
- 1 Department of Orthopedic Surgery, I-Shou University, Kaohsiung, Taiwan
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Abstract
As a result of immense heterogeneity with regard to morphology and stability, the recent literature lacks consensus concerning the treatment of sacral insufficiency fractures. We report the case of a 79-year-old woman with bilateral sacral insufficiency fractures following anterior pelvic ring fractures who was treated with teriparatide. During a two-week hospital stay, the patient was successfully mobilised and the regularly conducted pelvic X‑ray controls showed full consolidation of the fractures.
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Puffer RC, Gates MJ, Copeland W, Krauss WE, Fogelson J. Tarlov Cyst Causing Sacral Insufficiency Fracture. Oper Neurosurg (Hagerstown) 2019; 13:E4-E7. [PMID: 28521343 DOI: 10.1093/ons/opw025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 11/10/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Tarlov cysts, also known as perineural cysts, have been described as meningeal dilations of the spinal nerve root sheath between the peri- and endoneurium at the dorsal root ganglion. Most often they are found in the sacrum involving the nerve roots. Normally asymptomatic, they have been reported to present with radiculopathy, paresthesias, and even urinary or bowel dysfunction. Sacral insufficiency has not been a well-documented presentation. CLINICAL PRESENTATION The patient is a 38-year-old female who started to develop left low back pain and buttock pain that rapidly progressed into severe pain with some radiation down the posterior aspect of her left leg. There was no recent history of spine or pelvic trauma. These symptoms prompted her initial emergency department evaluation, and imaging demonstrated a large Tarlov cyst with an associated sacral insufficiency fracture. She was noted to have a normal neurological examination notable only for an antalgic gait. She was taken to surgery via a posterior approach and the cyst was identified eccentric to the left. The cyst was fenestrated and the nerve roots identified. Given her large area of bone erosion and insufficiency fractures, fixation of the sacroiliac joints was deemed necessary. Fusion was extended to the L5 vertebral body to buttress the fixation. She tolerated the procedure well and was discharged from the hospital on postoperative day 3. CONCLUSION Tarlov cysts of the sacrum can lead to significant bone erosion and subsequent insufficiency fractures, requiring fenestration and in some cases, complex sacropelvic fixation.
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Diagnosis of Insufficiency Fracture After Radiotherapy in Patients With Cervical Cancer: Contribution of Technetium Tc 99m-Labeled Methylene Diphosphonate Single-Photon Emission Computed Tomography/Computed Tomography. Int J Gynecol Cancer 2019; 28:1369-1376. [PMID: 30095704 DOI: 10.1097/igc.0000000000001337] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Insufficiency fractures (IFs) are a type of stress fracture caused by the effects of normal or physiological stresses on abnormally weakened bone. Frequently, these fractures are occult, and a portion of these fractures is misdiagnosed as bone metastases on a whole-body bone scan (WBS). The aim of this study was to evaluate a potential benefit of single-photon emission computed tomography/computed tomography (SPECT/CT) with metabolic and morphological imaging to diagnose IF in patients with cervical cancer after radiotherapy. METHODS This article presents a retrospective review of 35 patients with cervical cancer after radiotherapy in patients (females; mean age, 55.94 ± 8.75 years; range, 36-73 years) who were referred to have WBS to determine whether there was any bone metastasis. The criterion standard was based on radiological investigations, clinical information, and follow-up at a minimum of 12 months. RESULTS Insufficiency fractures were most frequently observed in the sacrum, accounting for 52.5% (21/40) of lesions. Fracture lines or sclerotic lines were noted in the IF lesion in 19 of 40 lesions on CT, and osteosclerosis was seen in 31 of 40 lesions. On WBS analysis, the sensitivity for detected lesions was 87.5% (42/48) for WBS. Nineteen lesions were interpreted as benign, 6 lesions were malignant, and 21 (43.8%) lesions were equivocal. Based on the criterion standard, WBS had an accuracy of only 47.9% (23/48). On SPECT/CT analysis, all of the lesions were observed on SPECT/CT; only 3 (6.25%) of 48 lesions were equivocal, and the accuracy was 89.6% (43/48). CONCLUSIONS Single-photon emission computed tomography/computed tomography should be included in the differential diagnoses when lesions show elevated technetium Tc 99m-labeled methylene diphosphonate uptake on WBS. Compared with a WBS alone, a more accurate diagnosis of IF can be obtained using SPECT/CT, which resulted not only in fewer equivocal lesions but also in a higher diagnostic accuracy.
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Pulley BR, Cotman SB, Fowler TT. Surgical Fixation of Geriatric Sacral U-Type Insufficiency Fractures: A Retrospective Analysis. J Orthop Trauma 2018; 32:617-622. [PMID: 30211791 DOI: 10.1097/bot.0000000000001308] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To define the incidence of sacral U-type insufficiency fracture and describe management of a consecutive series of patients with this injury. DESIGN Retrospective analysis. SETTING Single Level II trauma center. PATIENTS/PARTICIPANTS Sixteen adult patients with sacral U-type insufficiency fractures treated over a 36-month period. INTERVENTION Patients were indicated for percutaneous screw fixation of the posterior pelvis if they had posterior pelvic pain that prohibited mobilization. MAIN OUTCOME MEASUREMENTS Visual analog scale for pain, distance ambulated on postoperative day 1, and change in sacral kyphosis. RESULTS The sacral U-type insufficiency fracture incidence was 16.7% (19/114); average patient age was 75 years. Delayed surgery was performed after primary nonoperative treatment had failed in 62.5% (10/16) at an average 83 days postinjury. Acute surgery was performed in 37.5% (6/16) at an average 5 days postinjury. Distance ambulated on postoperative day 1 was 114.4 feet [95% confidence interval (CI) (50.6, 178.2)] and 88.7 feet [95% CI (2.8, 174.6)] in the delayed and acute surgery groups, respectively, P = 0.18. Change in visual analog scale for pain was -3.2 [95% CI (-5.0, -1.4)] and -3.7 [95% CI (-7.0, -0.4)] in the delayed and acute surgery groups, respectively, P = 0.15. Change in sacral kyphosis from presentation to surgery was 12.3 degrees [95% CI (6.7, 17.9)] and 0.3 degrees [95% CI (-0.2, 0.9)] in the delayed and acute surgery groups, respectively, P < 0.01. Minimum follow-up was 12 months. CONCLUSIONS Treatment of sacral U-type insufficiency fractures by percutaneous screw fixation permits early mobilization, provides rapid pain relief, and prevents progressive deformity. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Benjamin R Pulley
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA
| | - Steven B Cotman
- Department of Orthopaedic Surgery, Mount Carmel Health System, Columbus, OH
| | - T Ty Fowler
- Department of Orthopaedic Surgery, Mount Carmel Health System, Columbus, OH.,Orthopedic ONE, Columbus, OH
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Percutaneous Transiliac-Transsacral Screw Fixation of Sacral Fragility Fractures Improves Pain, Ambulation, and Rate of Disposition to Home. J Orthop Trauma 2018; 32:452-456. [PMID: 29916895 DOI: 10.1097/bot.0000000000001243] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether percutaneous transiliac-transsacral screw fixation improves pain, ambulation, length of stay, and the rate of disposition to home in patients with sacral fragility fractures. DESIGN Retrospective cohort study. SETTING Single academic Level 1 trauma center. PATIENTS/PARTICIPANTS Elderly patients who presented with an isolated sacral fragility fracture between August 2015 and August 2017. Of the 41 patients included in the study, 16 were treated operatively and 25 were treated nonoperatively. INTERVENTION Percutaneous transiliac-transsacral screw fixation. MAIN OUTCOME MEASUREMENTS Pain, ambulation, length of stay, complications, and disposition. RESULTS Patients treated operatively reported a greater improvement in pain as measured by the visual analog scale (3.9 vs. 0.6 points, P < 0.001). At the time of discharge, 100% of surgically treated patients were able to ambulate compared with 72% in the nonoperative group (P = 0.03). Average distance ambulating at the time of discharge was higher in the operative group (95 vs. 35 ft, P < 0.01). Length of stay was similar between the 2 groups (3.6 days in operative group vs. 4.2 days in nonoperative group, P = 0.5). Of the patients treated operatively, 75% were discharged to home compared with only 20% in the nonoperative group (P < 0.001). There were no complications related to surgery. CONCLUSIONS Percutaneous transiliac-transsacral screw fixation of sacral fragility fractures lessens pain, improves ambulation, and increases the rate of disposition to home. Further investigation is needed to determine if surgical fixation provides benefit regarding medium- and long-term outcome variables. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Chuen CK, Watson J, Kantak A, Panose P. Low and high energy pelvic injuries. Br J Hosp Med (Lond) 2018; 79:C103-C107. [PMID: 29995536 DOI: 10.12968/hmed.2018.79.7.c103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chi Kit Chuen
- Orthopaedic CT2, Department of Trauma and Orthopaedics, East Surrey Hospital, Redhill, Surrey RH1 5RH
| | - Jay Watson
- Orthopaedic ST5, Department of Trauma and Orthopaedics, East Surrey Hospital, Redhill, Surrey
| | - Avadhoot Kantak
- Trauma and Orthopaedic Consultant, Department of Trauma and Orthopaedics, East Surrey Hospital, Redhill, Surrey
| | - Praveen Panose
- Trauma and Orthopaedic Consultant, Department of Trauma and Orthopaedics, East Surrey Hospital, Redhill, Surrey
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Bencardino JT, Stone TJ, Roberts CC, Appel M, Baccei SJ, Cassidy RC, Chang EY, Fox MG, Greenspan BS, Gyftopoulos S, Hochman MG, Jacobson JA, Mintz DN, Mlady GW, Newman JS, Rosenberg ZS, Shah NA, Small KM, Weissman BN. ACR Appropriateness Criteria ® Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excluding Other Vertebrae. J Am Coll Radiol 2018; 14:S293-S306. [PMID: 28473086 DOI: 10.1016/j.jacr.2017.02.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022]
Abstract
Stress fractures, including both fatigue and insufficiency types, are frequently encountered in clinical practice as a source of pain in both athletes and patients with predisposing conditions. Radiography is the imaging modality of choice for baseline diagnosis. MRI has greatly improved our ability to diagnose radiographically occult stress fractures. Tc-99m bone scan and CT may also be useful as diagnostic tools. Although fatigue and insufficiency fractures can be self-limited and go onto healing even without diagnosis, there is usually value in initiating prompt therapeutic measures as incomplete stress fractures have the potential of progressing to completion and requiring more invasive treatment or delay in return to activity. This is particularly important in the setting of stress fractures of the femoral neck. Accuracy in the identification of these injuries is also relevant because the differential diagnosis includes entities that would otherwise be treated significantly different (ie, osteoid osteoma, osteomyelitis, and metastasis). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jenny T Bencardino
- Principal Author and Panel Vice-Chair, New York University School of Medicine, New York, New York.
| | - Taylor J Stone
- Research Author, Charlotte Radiology, Charlotte, North Carolina
| | | | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons
| | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | - Eric Y Chang
- VA San Diego Healthcare System, San Diego, California
| | - Michael G Fox
- University of Virginia Health System, Charlottesville, Virginia
| | | | | | - Mary G Hochman
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jon A Jacobson
- University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Gary W Mlady
- University of New Mexico, Albuquerque, New Mexico
| | | | | | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
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Clinical and imaging mimickers of axial spondyloarthritis. Semin Arthritis Rheum 2017; 47:361-368. [DOI: 10.1016/j.semarthrit.2017.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/08/2017] [Accepted: 05/19/2017] [Indexed: 12/15/2022]
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Kasukawa Y, Miyakoshi N, Ebina T, Hongo M, Ishikawa Y, Kudo D, Nozaka K, Shimada Y. Enhanced bone healing and decreased pain in sacral insufficiency fractures after teriparatide treatment: retrospective clinical-based observational study. ACTA ACUST UNITED AC 2017; 14:140-145. [PMID: 29263722 DOI: 10.11138/ccmbm/2017.14.1.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this retrospective clinical-based observational study was to evaluate the effects of teriparatide (TPTD) on clinical outcomes and radiologic findings of sacral insufficiency fractures (SIFs). Seven elderly women with SIFs received TPTD for at least 6 months. We evaluated the symptoms, pain, and radiological findings. At their initial clinic visit, 86% patients could not walk or sit. Computed tomography (CT) images revealed sacral wing fracture in 6 patients, and bone scintigram showed H-shaped uptake over the bilateral sacral wings in 1 patient. After the treatment, 5 patients could walk. Mean visual analog scale score was significantly lower after (12.9 mm) than before (87.4 mm) TPTD treatment (p < 0.0001). CT images revealed bone union (four patients) and sclerotic changes (three patients) at the fracture sites. Seven elderly women with SIFs had significant improvement in pain and demonstrated bone union or sclerotic changes at fracture sites by TPTD.
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Affiliation(s)
- Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.,Akita Bone and Osteoporosis Network (A-BONE)
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.,Akita Bone and Osteoporosis Network (A-BONE)
| | - Toshihito Ebina
- Department of Orthopedic Surgery, Kakunodate General Hospital, Senboku, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.,Akita Bone and Osteoporosis Network (A-BONE)
| | - Yoshinori Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.,Akita Bone and Osteoporosis Network (A-BONE)
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.,Akita Bone and Osteoporosis Network (A-BONE)
| | - Koji Nozaka
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.,Akita Bone and Osteoporosis Network (A-BONE)
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.,Akita Bone and Osteoporosis Network (A-BONE)
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Kanakaris NK, Greven T, West RM, Van Vugt AB, Giannoudis PV. Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected? INTERNATIONAL ORTHOPAEDICS 2017; 41:1813-1824. [PMID: 28733846 DOI: 10.1007/s00264-017-3567-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/30/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE The incidence of low energy pelvic fractures (FPFs) in the elderly is increasing. Comorbidities, decreased bone-quality, problematic fracture fixation and poor compliance represent some of their specific difficulties. In the absence of uniform management, a standard operating procedure (SOP) was introduced to our unit, aiming to improve the quality of services provided to these patients. METHODS A cohort study was contacted to test the impact of (1) using a specific clinical algorithm and (2) using different antiosteoporotic drugs. Multivariate regression analysis was used to determine prognostic factors. Study endpoints were the time-to-healing, length-of-stay, return to pre-injury mobility, union status, mortality and complications. RESULTS A total of 132 elderly patients (≥65 years) admitted during the period 2012-2014 with FPFs were enrolled. High-energy fractures, acetabular fractures, associated trauma affecting mobility, pathological pelvic lesions and operated FPFs were used as exclusion criteria. The majority of included patients were females (108/132; 81.8%), and the mean age was 85.8 years (range 67-108). Use of antiosteoporotics was associated with a shorter time of healing (p = 0.036). Patients treated according to the algorithm showed a significant protection against malunion (p < 0.001). Also, adherence to the algorithm allowed more patients to return to their pre-injury mobility status (p = 0.039). CONCLUSIONS The use of antiosteoporotic medication in elderly patients with fragility pelvic fractures was associated with faster healing, whilst the adherence to a structured clinical pathway led to less malunions and non-unions and return to pre-injury mobility state.
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Affiliation(s)
- Nikolaos K Kanakaris
- Clinical Lead Major Trauma Centre, Academic Department of Trauma & Orthopaedics, Leeds Teaching Hospitals, Leeds, UK. .,Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Clarendon Wing, Level A, Leeds, West Yorkshire, LS13EX, UK. .,Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.
| | - Tess Greven
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.,Medisch Spectrum Twente, Enschede, The Netherlands
| | - Robert M West
- Department of Biostatistics, University of Leeds, Leeds, UK
| | - Arie B Van Vugt
- Department of Trauma Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
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Beckmann NM, Chinapuvvula NR. Sacral fractures: classification and management. Emerg Radiol 2017; 24:605-617. [DOI: 10.1007/s10140-017-1533-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/19/2017] [Indexed: 12/16/2022]
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Höch A, Özkurtul O, Pieroh P, Josten C, Böhme J. Outcome and 2-Year Survival Rate in Elderly Patients With Lateral Compression Fractures of the Pelvis. Geriatr Orthop Surg Rehabil 2016; 8:3-9. [PMID: 28255503 PMCID: PMC5315241 DOI: 10.1177/2151458516681142] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 09/12/2016] [Accepted: 10/09/2016] [Indexed: 12/16/2022] Open
Abstract
Introduction: Osteoporotic pelvic ring fractures are a rising problem for surgeons in industrialized countries. There is no evidence-based treatment strategy especially for lateral compression (LC) fractures involving the sacrum. The aim of this study was to evaluate and compare outcome and survival rate of nonoperative and operative treatment strategies for lateral compression fractures. Patients and Methods: In a retrospective study, 128 patients (aged ≥65 years) with an Orthopedic Trauma Association (OTA) types B2.1 and B3.3 fracture were included and analyzed regarding demographic and treatment data and adverse events. After a follow-up period of at least 2-year survival rate, quality of life and pain were evaluated using the EuroQol-5D and Short Form–12 questionnaires and the visual analog scale. Results: Fifty patients (78.3 ± 7.6 years) obtained operative treatment and 77 patients (82.7 ± 7.9 years) obtained nonoperative treatment. One died within 24 hours after admission. High rates of complications occurred in both groups (operative group: 18% and nonoperative group: 8%). Eighteen percent (14 of the 77) of conservatively treated patients needed operative treatment after discharge due to worsening pain and mobilization. The 2-year follow-up showed a high overall mortality (30%), with a significant higher survival rate for operatively treated patients (2-year survival: operatively treated 82% vs conservative 61%). No difference was found in pain and quality of life. Discussion: Elderly patients display a high rate and variety of complications and mortality in the aftermath of lateral compression fractures of the pelvis. Although a significantly higher 2-year survival rate for operatively treated patients was found, this study cannot give proof of superior position for operative treatment. Due to lacking data for alternative treatment algorithms especially for fracture-related immobilized patients, we recommended operative treatment with the aim to reduce complications related to prolonged bed rest and ensure early mobilization.
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Affiliation(s)
- Andreas Höch
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Orkun Özkurtul
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Philipp Pieroh
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany; Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christoph Josten
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Jörg Böhme
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
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Maier GS, Kolbow K, Lazovic D, Horas K, Roth KE, Seeger JB, Maus U. Risk factors for pelvic insufficiency fractures and outcome after conservative therapy. Arch Gerontol Geriatr 2016; 67:80-5. [DOI: 10.1016/j.archger.2016.06.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 01/05/2023]
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Transsacral-Transiliac Screw Stabilization: Effective for Recalcitrant Pain Due to Sacral Insufficiency Fracture. J Orthop Trauma 2016; 30:469-73. [PMID: 27551916 DOI: 10.1097/bot.0000000000000596] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of transsacral-transiliac screw fixation for the treatment of sacral insufficiency fractures that fail nonoperative treatment. DESIGN A pilot study series of consecutive patients identified over 5 years were treated and followed prospectively. SETTING Academic-affiliated, tertiary referral, level 1 trauma center in Dallas, TX. PATIENTS/PARTICIPANTS Patients were selected on the basis of presenting diagnosis, and failure of nonoperative treatment of their sacral insufficiency fracture. Eleven patients entered to the study, and 10 completed follow-up. INTERVENTION Placement of transsacral-transiliac screws for sacral insufficiency fracture. MAIN OUTCOME MEASUREMENTS Comparison of preoperative and postoperative Visual Analog Scale scores and Oswestry Low Back Disability Index scores. RESULTS Patients experienced statistically significant improvement in both outcome measures after intervention. No complications encountered. CONCLUSIONS Transsacral-transiliac screw fixation seems to be a safe and effective treatment for sacral insufficiency fractures recalcitrant to nonoperative management. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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40
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Matar HE, Hassan K, Duckett SP. Insufficiency sacral fracture-dislocation mimicking suicidal jumper's fracture. BMJ Case Rep 2016; 2016:bcr-2016-216587. [PMID: 27571917 DOI: 10.1136/bcr-2016-216587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Hosam E Matar
- Specialty Registrar, Department of Trauma & Orthopaedics, Leighton Hospital, Crewe, UK
| | - Kamran Hassan
- Consultant Spinal Surgeon, Salford Royal Hospital, Salford, UK
| | - Stephen P Duckett
- Consultant Trauma & Orthopaedic Surgeon, Leighton Hospital, Crewe, UK
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Wagner D, Kamer L, Sawaguchi T, Richards RG, Noser H, Rommens PM. Sacral Bone Mass Distribution Assessed by Averaged Three-Dimensional CT Models: Implications for Pathogenesis and Treatment of Fragility Fractures of the Sacrum. J Bone Joint Surg Am 2016; 98:584-90. [PMID: 27053587 DOI: 10.2106/jbjs.15.00726] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fragility fractures of the sacrum are increasing in prevalence due to osteoporosis and epidemiological changes and are challenging in their treatment. They exhibit specific fracture patterns with unilateral or bilateral fractures lateral to the sacral foramina, and sometimes an additional transverse fracture leads to spinopelvic dissociation. The goal of this study was to assess sacral bone mass distribution and corresponding changes with decreased general bone mass. METHODS Clinical computed tomography (CT) scans of intact pelves in ninety-one individuals (mean age and standard deviation, 61.5 ± 11.3 years) were used to generate three-dimensional (3D) models of the sacrum averaging bone mass in Hounsfield units (HU). Individuals with decreased general bone mass were identified by measuring bone mass in L5 (group 1 with <100 HU; in contrast to group 2 with ≥100 HU). RESULTS In group 1, a large zone of negative Hounsfield units was located in the paraforaminal lateral region from S1 to S3. Along the trans-sacral corridors, a Hounsfield unit peak was observed laterally, corresponding to cortical bone of the auricular surface. The lowest Hounsfield unit values were found in the paraforaminal lateral region in the sacral ala. An intermediate level of bone mass was observed in the area of the vertebral bodies, which also demonstrated the largest difference between groups 1 and 2. Overall, the Hounsfield units were lower at S2 than S1. CONCLUSIONS The models of averaged bone mass in the sacrum revealed a distinct 3D distribution pattern. CLINICAL RELEVANCE The negative values in the paraforaminal lateral region may explain the specific fracture patterns in fragility fractures of the sacrum involving the lateral areas of the sacrum. Transverse fractures located between S1 and S2 leading to spinopelvic dissociation may occur because of decreased bone mass in S2. The largest difference between the studied groups was found in the vertebral bodies and might support the use of transsacral or cement-augmented implants.
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Affiliation(s)
- Daniel Wagner
- AO Research Institute Davos, Davos, Switzerland Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
| | - Lukas Kamer
- AO Research Institute Davos, Davos, Switzerland
| | - Takeshi Sawaguchi
- Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan
| | | | | | - Pol M Rommens
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
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Anderson ME, Wu JS, Vargas SO. CORR(®) Tumor Board: Sacral Insufficiency Fractures are Common After High-dose Radiation for Sacral Chordomas Treated With or Without Surgery. Clin Orthop Relat Res 2016; 474:630-2. [PMID: 26642785 PMCID: PMC4746151 DOI: 10.1007/s11999-015-4651-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/23/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Megan E. Anderson
- grid.239395.70000000090118547Orthopaedic Oncology Surgeon, Beth Israel Deaconess Medical Center and Boston Children’s Hospital, 330 Brookline Ave., Boston, MA 02215 USA
| | - Jim S. Wu
- grid.239395.70000000090118547Musculoskeletal Radiologist, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Sara O. Vargas
- grid.2515.30000000403788438Staff Pathologist, Boston Children’s Hospital, Boston, MA USA
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Memetoğlu OG, Ozkan FU, Boy NS, Aktas I, Kulcu DG, Taraktas A. Sacroiliitis or insufficiency fracture? Osteoporos Int 2016; 27:1265-1268. [PMID: 26501559 DOI: 10.1007/s00198-015-3363-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
Sacral stress fracture and sacroiliitis are two conditions that present with pain. Sacral stress fractures are a rare cause of lumbar and hip pain. Sacral insufficiency fractures are a type of sacral stress fractures. Sacroiliitis represents inflammation of the sacroiliac joints. Coexistence of sacroiliitis and sacral insufficiency fracture (SIF) has not been reported before. Case 1: A 39-year-old woman reporting inflammatory back pain. Imaging revealed bilateral chronic sacroiliitis and bilateral SIF. Case 2: A 31-year-old woman presenting with left hip and inguinal pain. Imaging revealed left sacroiliitis and ipsilateral SIF. Calcium and vitamin D supplementation together with nonsteroidal anti-inflammatory drug (NSAID) treatment were given. Sulfasalazine was added to the treatment of the second patient who developed peripheral arthritis during follow-ups. Early diagnosis is best made with magnetic resonance imaging (MRI) since roentgenograms may be negative initially. Furthermore, MRI findings of both entities share common features leading to a diagnostic dilemma. Interpretation of radiological findings assisted by detailed history and clinical findings is crucial for diagnosis and treatment.
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Affiliation(s)
- O G Memetoğlu
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - F U Ozkan
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - N S Boy
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - I Aktas
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - D G Kulcu
- Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - A Taraktas
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Jeong M, Jin JW, Shin SJ, Kang BY. Calcaneal Insufficiency Fracture after Ipsilateral Total Knee Arthroplasty. J Bone Metab 2016; 23:45-8. [PMID: 26981521 PMCID: PMC4791438 DOI: 10.11005/jbm.2016.23.1.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/05/2016] [Accepted: 02/07/2016] [Indexed: 11/17/2022] Open
Abstract
Insufficiency fracture of the calcaneus is a rare entity. In the absence of trauma, evaluating a painful ankle in an elderly patient can be difficult and also it might be overlook the insufficiency fracture. We experienced a case of insufficiency calcaneus fracture that occurred after ipsilateral total knee arthroplasty. Here, we report our case with a review of literatures.
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Affiliation(s)
- Min Jeong
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jin Woo Jin
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sung Jin Shin
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Byoung Youl Kang
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Hassan MS. Sacroplasty for sacral insufficiency fractures. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Yoo JH, Moon SH, Ha YC, Lee DY, Gong HS, Park SY, Yang KH. Osteoporotic Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research. J Bone Metab 2015; 22:175-81. [PMID: 26713308 PMCID: PMC4691591 DOI: 10.11005/jbm.2015.22.4.175] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 11/11/2022] Open
Abstract
Osteoporotic fractures are one of the most common causes of disability and a major contributor to medical care costs worldwide. Prior osteoporotic fracture at any site is one of the strongest risk factors for a new fracture, which occurs very soon after the first fracture. Bone mineral density (BMD) scan, a conventional diagnostic tool for osteoporosis, has clear limitations in diagnosing osteoporotic fractures and identifying the risk of subsequent fractures. Therefore, early and accurate diagnosis of osteoporotic fractures using the clinical definition which is applicable practically and independent of BMD, is essential for preventing subsequent fractures and reducing the socioeconomic burden of these fractures. Fractures caused by low-level trauma equivalent to a fall from a standing height or less at major (hip, spine, distal radius, and proximal humerus) or minor (pelvis, sacrum, ribs, distal femur and humerus, and ankle) sites in adults over age 50, should be first regarded as osteoporotic. In addition, if osteoporotic fractures are strongly suspected on history and physical examination even though there are no positive findings on conventional X-rays, more advanced imaging techniques such as computed tomography, bone scan, and magnetic resonance imaging are necessary as soon as possible.
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Affiliation(s)
- Je-Hyun Yoo
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Seong-Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dong Yeon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Si Young Park
- Department of Orthopaedic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kyu Hyun Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
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Bone Health and Pelvic Radiotherapy. Clin Oncol (R Coll Radiol) 2015; 27:668-78. [DOI: 10.1016/j.clon.2015.07.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/19/2015] [Indexed: 12/26/2022]
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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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50
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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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