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Sacral Insufficiency Fractures : How to Classify?

Gesa Bakker1, Joerg Hattingen2, Hartmut Stuetzer3

  • 1Hannover Region Public Health Department, Hannover Region, Hannover, Germany.

Journal of Korean Neurosurgical Society
|March 12, 2018
PubMed
Summary
This summary is machine-generated.

This study introduces a new classification for sacral insufficiency fractures in elderly patients, distinguishing between less severe injuries and those requiring intervention. The classification aids in assessing risks for procedures like sacroplasty and identifying fractures needing surgical stabilization.

Keywords:
CementoplastyClassificationInsufficiency fracturesSacrum

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Area of Science:

  • Orthopedics
  • Radiology
  • Geriatric Medicine

Background:

  • Sacral insufficiency fractures are increasingly diagnosed in the elderly population.
  • These fractures exhibit diverse morphologies, complicating diagnosis and treatment planning.

Purpose of the Study:

  • To develop a classification system for sacral insufficiency fractures based on cortical break location.
  • To assess the potential need for intervention and associated risks.

Main Methods:

  • Prospective registration of 130 patients (117 female, 13 male) with sacral insufficiency fractures between 2008 and 2014.
  • All patients underwent computed tomography (CT) of the pelvic ring; two had additional magnetic resonance imaging (MRI).
  • Fracture lines were analyzed for localization and involvement of the sacroiliac joint, neural foramina, and spinal canal.

Main Results:

  • 171 fractures were analyzed in patients aged 46-98 years (mean 79.8).
  • Fractures were categorized into sacral ala (Group A, n=53; Group B, n=106) and sacral corpus (Group C, n=12).
  • Group B fractures showed significant involvement of the sacroiliac joint (n=68) and neural foramina/spinal canal (n=34).

Conclusions:

  • The proposed classification differentiates fractures of lesser mechanical importance.
  • It enables risk assessment for polymethyl methacrylate leaks during sacroplasty.
  • Facilitates identification of unstable fractures requiring surgical stabilization such as laminectomy.