Sacral insufficiency fracture
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Causes
- Postmenopausal osteoporosis (most common)
- Senile osteoporosis
- Pelvic irradiation
- Corticosteroid therapy
- Rheumatoid arthritis
Diagnosis
History and Symptoms
- 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.
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
