Pelvic insufficiency fractures

Case contributed by Dr Mostafa El-Feky

Presentation

Low back pain. No history of trauma.

Patient Data

Age: 80 years
Gender: Female
MRI

Pelvis

Bilateral vertical fractures of the sacral alae are noted showing minimal anterior displacement on the right side and extension to the right 1st and 2nd sacral neural foramina with moderate surrounding marrow edema.

Moderate marrow edema is noted at the posterior part of the right iliac bone, underlying non-displaced fracture.

These fractures are noted on a background of bilateral degenerative sacroiliac joint changes.

The visualized superior pubic rami showed a comminuted fracture of right superior pubic ramus with mild fluid collection at the fracture edges.

Minimal pelvic collection is seen. 

CT

Pelvis

Bilateral vertical fractures of the sacral alae are noted showing minimal displacement on the right side and extension to the right 1st and 2nd sacral neural foramina.

Non-displaced fracture of the posterior part of the right iliac bone.

Non-displaced comminuted fracture of the right superior pubic ramus.

Displaced comminuted fracture of the right inferior pubic ramus is noted showing posterior displacement of the lateral fragment.

Old healed fracture of the left inferior pubic ramus is seen.

These fractures are noted on a background of osteoporotic changes of the examined bones.

Bilateral degenerative sacroiliac joint disease.

Normal osseous features of left iliac bone having preserved cortical outline and normal trabecular pattern. 

Case Discussion

As regards no history of trauma, elderly female patient and multiple sacral and pelvic fractures, pelvic insufficiency fractures are the most likely etiology, mostly secondary to osteoporosis. They are considered a subtype of stress fractures.

Sacral insufficiency fractures are the most common, they usually run vertically through the sacral ala, paralleling the sacroiliac joint. This pattern gives H appearance, known as Honda sign. Pubic rami fractures usually occur in conjunction with insufficiency fractures elsewhere within the pelvis.

 

Case courtesy Dr Rim Bastawy, Lecturer of radiodiagnosis, Alexandria university, Egypt.

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Case information

rID: 68410
Published: 17th Jul 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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