Daniel Wagner1,2, Alexander Hofmann3, Lukas Kamer4, Takeshi Sawaguchi5, R Geoff Richards4, Hansrudi Noser4, Dominik Gruszka3, Pol M Rommens3. 1. Department of Orthopaedics and Traumatology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany. wagner.daniel@gmx.ch. 2. AO Research Institute Davos, Davos, Switzerland. wagner.daniel@gmx.ch. 3. Department of Orthopaedics and Traumatology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany. 4. AO Research Institute Davos, Davos, Switzerland. 5. Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan.
Abstract
INTRODUCTION: Patients suffering from osteoporosis-associated fragility fractures of the sacrum (FFS; also termed sacral insufficiency fractures) are increasingly observed. They have typical fracture patterns with fracture lines located in the sacral ala. When treating these patients operatively, iliosacral screw loosening is not uncommon. We aimed to study the sacral bone mass in patients presenting with a FFS using 3D statistical models. MATERIALS AND METHODS: 3D models of averaged Hounsfield units (HU) were generated based on CT scans from 13 patients with a unilateral FFS (mean age 79.6 years; 11 females, 2 males). The control group without fractures consisted of 28 males and 32 females (mean age of 68.3 years). A virtual bone probe along the trans-sacral corridors S1 and S2 was taken. RESULTS: The bone mass distribution in the fractured sacra was similar to the control group, however, with overall lower HU. Large zones of negative HU were located in the sacral ala. In the fractured sacra, the HU in the sacral ala was significantly lower on the non-injured side when comparing to the fractured side (p < 0.001) as well as compared to the non-fractured group (p < 0.001). Low bone mass was observed in sacral body S1 (40 HU) and S2 (20 HU). CONCLUSIONS: The extensive area of negative HU may explain the fracture location in the sacral ala. The low HU in the sacral bodies advocates the use of trans-sacral implants or augmented iliosacral screws to enhance the strength of fracture fixation. The increased HU in the fractured ala could be explained by fracture-asssociated hemorrhage and can be used as a diagnostic tool.
INTRODUCTION:Patients suffering from osteoporosis-associated fragility fractures of the sacrum (FFS; also termed sacral insufficiency fractures) are increasingly observed. They have typical fracture patterns with fracture lines located in the sacral ala. When treating these patients operatively, iliosacral screw loosening is not uncommon. We aimed to study the sacral bone mass in patients presenting with a FFS using 3D statistical models. MATERIALS AND METHODS: 3D models of averaged Hounsfield units (HU) were generated based on CT scans from 13 patients with a unilateral FFS (mean age 79.6 years; 11 females, 2 males). The control group without fractures consisted of 28 males and 32 females (mean age of 68.3 years). A virtual bone probe along the trans-sacral corridors S1 and S2 was taken. RESULTS: The bone mass distribution in the fractured sacra was similar to the control group, however, with overall lower HU. Large zones of negative HU were located in the sacral ala. In the fractured sacra, the HU in the sacral ala was significantly lower on the non-injured side when comparing to the fractured side (p < 0.001) as well as compared to the non-fractured group (p < 0.001). Low bone mass was observed in sacral body S1 (40 HU) and S2 (20 HU). CONCLUSIONS: The extensive area of negative HU may explain the fracture location in the sacral ala. The low HU in the sacral bodies advocates the use of trans-sacral implants or augmented iliosacral screws to enhance the strength of fracture fixation. The increased HU in the fractured ala could be explained by fracture-asssociated hemorrhage and can be used as a diagnostic tool.
Authors: Daniel Wagner; Miha Kisilak; Geoffrey Porcheron; Sven Krämer; Isabella Mehling; Alexander Hofmann; Pol M Rommens Journal: Sci Rep Date: 2021-07-09 Impact factor: 4.379
Authors: Darius M Thiesen; Dimitris Ntalos; Josephine Berger-Groch; Andreas Petersik; Bernhard Hofstätter; Karl-Heinz Frosch; Maximilian J Hartel Journal: Sci Rep Date: 2020-03-30 Impact factor: 4.379
Authors: Pol Maria Rommens; Roland Schwab; Kristin Handrich; Charlotte Arand; Daniel Wagner; Alexander Hofmann Journal: Int Orthop Date: 2020-07-30 Impact factor: 3.075
Authors: Pol Maria Rommens; Eva Mareike Nolte; Johannes Hopf; Daniel Wagner; Alexander Hofmann; Martin Hessmann Journal: Eur J Trauma Emerg Surg Date: 2020-04-15 Impact factor: 3.693