Bakker, Gesa, Hattingen, Joerg, Stuetzer, Hartmut and Isenberg, Joerg (2018). Sacral Insufficiency Fractures : How to Classify? J. Korean. Neurosurg. Soc., 61 (2). S. 258 - 267. SEOUL: KOREAN NEUROSURGICAL SOC. ISSN 1598-7876

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Abstract

Objective : The 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. Methods : Between 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. Results : Patients 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. Conclusion : The 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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Bakker, GesaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hattingen, JoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stuetzer, HartmutUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Isenberg, JoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-194853
DOI: 10.3340/jkns.2017.0188
Journal or Publication Title: J. Korean. Neurosurg. Soc.
Volume: 61
Number: 2
Page Range: S. 258 - 267
Date: 2018
Publisher: KOREAN NEUROSURGICAL SOC
Place of Publication: SEOUL
ISSN: 1598-7876
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
PERCUTANEOUS SACROPLASTY; STRESS-FRACTURES; CLASSIFICATION; MANAGEMENT; PAINMultiple languages
Clinical Neurology; SurgeryMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/19485

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