Sacral insufficiency fracture

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

• Typically, patients present with groin, low back, or buttock pain.
• Patients present with either no history of trauma or a history of low impact trauma.

Causes

• Postmenopausal osteoporosis (most common)
• Senile osteoporosis
• Pelvic irradiation
• Corticosteroid therapy
• Rheumatoid arthritis

Diagnostic Findings

Plain film

• The most common finding is a sclerotic band or line.
• Lytic fracture line or cortical break rarely is observed.

CT

• Sacral fractures typically are oriented vertically and located parallel to the sacroiliac joints.
• Linear fracture line with surrounding sclerosis is observed.

MRI

• Decreased signal on T1-weighted images and increased signal on T2-weighted images.
• Signal changes are seen as linear bands within the sacral ala and body and are parallel to the sacroiliac joints.
• On T2-weighted images, the fracture line may be seen if it is surrounded by adjacent marrow edema.

Nuclear Medicine

• H or "Honda sign" which indicated horizontal involvement of the sacrum and vertical involvement of the sacral ala
• The "dot and dash" pattern is another common appearance.

Images

Images courtesy of RadsWiki

Lower back pain. History of pelvic radiation therapy

Lower back pain. History of pelvic radiation therapy

Lower back pain. History of pelvic radiation therapy

External Links

• Goldminer: Sacral insufficiency fracture

References

• Wilfred CG. E-medicine rads article

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