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Occult sacral fractures in osteopenic patients.
K E Newhouse1, G Y el-Khoury, J A Buckwalter
1Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1088.
The Journal of Bone and Joint Surgery. American Volume
|December 1, 1992
Summary
Occult sacral fractures are common in elderly osteopenic women, often without trauma. Early diagnosis with CT or bone scan and conservative treatment can restore mobility.
Area of Science:
- Orthopedics
- Radiology
- Geriatrics
Background:
- Osteoporotic sacral fractures present diagnostic challenges, particularly in elderly women.
- These fractures often occur spontaneously or with minimal trauma.
- Associated pubic ramus fractures are common.
Observation:
- Seventeen osteopenic patients with occult sacral fractures were reviewed.
- Fourteen fractures occurred without significant trauma, and sixteen patients were elderly women.
- Nine patients had a history of pelvic malignancy, complicating diagnosis.
Findings:
- Computed tomography (CT) and bone scans were highly effective in diagnosing sacral fractures.
- Magnetic resonance imaging (MRI) showed limited specificity in these cases.
- Conservative management (assistive devices, reduced activity, non-narcotic analgesics) resolved symptoms in twelve patients.
Implications:
- Early diagnosis of occult sacral fractures is crucial for effective management.
- CT and bone scintigraphy are recommended imaging modalities.
- Conservative treatment can lead to independent ambulation in eligible patients.