Sacral Insufficiency Fractures : How to Classify?

Abstract

ObjectiveThe diagnosis of insufficiency fractures of the sacrum in an elder population increases annually. Fractures show very different morphology. We aimed to classify sacral insufficiency fractures according to the position of cortical break and possible need for intervention.MethodsBetween January 1, 2008 and December 31, 2014, all patients with a proven fracture of the sacrum following a low-energy or an even unnoticed trauma were prospectively registered : 117 females and 13 males. All patients had a computer tomography of the pelvic ring, two patients had a magnetic resonance imaging additionally : localization and involvement of the fracture lines into the sacroiliac joint, neural foramina or the spinal canal were identified.ResultsPatients were aged between 46 and 98 years (mean, 79.8 years). Seventy-seven patients had an unilateral fracture of the sacral ala, 41 bilateral ala fractures and 12 patients showed a fracture of the sacral corpus : a total of 171 fractures were analyzed. The first group A included fractures of the sacral ala which were assessed to have no or less mechanical importance (n=53) : fractures with no cortical disruption (“bone bruise”) (A1; n=2), cortical deformation of the anterior cortical bone (A2; n=4), and fracture of the anterolateral rim of ala (A3; n=47). Complete fractures of the sacral ala (B; n=106) : parallel to the sacroiliac joint (B1; n=63), into the sacroiliac joint (B2; n=19), and involvement of the sacral foramina respectively the spinal canal (B3; n=24). Central fractures involving the sacral corpus (C; n=12) : fracture limited to the corpus or finishing into one ala (C1; n=3), unidirectional including the neural foramina or the spinal canal or both (C2; n=2), and horizontal fractures of the corpus with bilateral sagittal completion (C3; n=8). Sixty-eight fractures proceeded into the sacroiliac joint, 34 fractures showed an injury of foramina or canal.ConclusionThe new classification allowes the differentiation of fractures of less mechanical importance and a risk assessment for possible polymethyl methacrylate leaks during sacroplasty in the direction of the neurological structures. In addition, identification of instable fractures in need for laminectomy and surgical stabilization is possible.

Incidence and Mortality of Osteoporotic Sacral Insufficiency Fractures: A Retrospective Singlecentre Study

“…When the results of bone mineral densitometry (BMD) that was measured by dualenergy X-ray absorptiometry method were evaluated, the mean value was found to be -3.62 ±0.46 (mean ± SD). According to the classification system of Bakker et al (7) of SIFs, the most common fracture type was B1. Numerical and percentage distribution of fracture types are shown in Graphic 2.…”

“…Table 1. Classification of sacral insufficiency fractures according to Bakker et al (7) Type A: Fractures of the sacral ala…”

“…However, the greatest loss of bone mass was shown to be in the alar regions. According to Bakker et al 's (7) sacral insufficiency fracture classification, type B fractures are located in the alar region. The fracture line extends along with the sagittal plane and parallel to the sacroiliac joint.…”

“…Patients' demographics and radiological features were examined. Besides, the fractures of the patients were classified according to the classification systems previously described by Bakker et al (7) in the literature (Table 1).…”

Successful treatment for bilateral femoral neck insufficiency fractures: a rare lesion case report and an updated review of the literature

“…IF is more common in the elderly, and less common in men than women. Recently, Bakker et al [6] published a study about the diagnose of Sacral IF for 130 patients, who aged between 46 and 98 years (mean, 79.8 years), with 117 females and 13 males. Melton et al [7] analyzed the contribution of gender on the incidence of pelvic insufficiency fractures in a retrospective review of a Mayo Medical database, of which total of 198 patients with 204 fractures, showed the incidence of pelvic insufficiency fractures was nearly twice as common in women (47.5/100000) as it is in men (24.4/100000).…”