PMID- 27053587
OWN - NLM
STAT- MEDLINE
DCOM- 20160815
LR  - 20161126
IS  - 1535-1386 (Electronic)
IS  - 0021-9355 (Linking)
VI  - 98
IP  - 7
DP  - 2016 Apr 6
TI  - Sacral Bone Mass Distribution Assessed by Averaged Three-Dimensional CT Models:
      Implications for Pathogenesis and Treatment of Fragility Fractures of the Sacrum.
PG  - 584-90
LID - 10.2106/JBJS.15.00726 [doi]
AB  - BACKGROUND: Fragility fractures of the sacrum are increasing in prevalence due to
      osteoporosis and epidemiological changes and are challenging in their treatment. 
      They exhibit specific fracture patterns with unilateral or bilateral fractures
      lateral to the sacral foramina, and sometimes an additional transverse fracture
      leads to spinopelvic dissociation. The goal of this study was to assess sacral
      bone mass distribution and corresponding changes with decreased general bone
      mass. METHODS: Clinical computed tomography (CT) scans of intact pelves in
      ninety-one individuals (mean age and standard deviation, 61.5 +/- 11.3 years)
      were used to generate three-dimensional (3D) models of the sacrum averaging bone 
      mass in Hounsfield units (HU). Individuals with decreased general bone mass were 
      identified by measuring bone mass in L5 (group 1 with <100 HU; in contrast to
      group 2 with >/=100 HU). RESULTS: In group 1, a large zone of negative Hounsfield
      units was located in the paraforaminal lateral region from S1 to S3. Along the
      trans-sacral corridors, a Hounsfield unit peak was observed laterally,
      corresponding to cortical bone of the auricular surface. The lowest Hounsfield
      unit values were found in the paraforaminal lateral region in the sacral ala. An 
      intermediate level of bone mass was observed in the area of the vertebral bodies,
      which also demonstrated the largest difference between groups 1 and 2. Overall,
      the Hounsfield units were lower at S2 than S1. CONCLUSIONS: The models of
      averaged bone mass in the sacrum revealed a distinct 3D distribution pattern.
      CLINICAL RELEVANCE: The negative values in the paraforaminal lateral region may
      explain the specific fracture patterns in fragility fractures of the sacrum
      involving the lateral areas of the sacrum. Transverse fractures located between
      S1 and S2 leading to spinopelvic dissociation may occur because of decreased bone
      mass in S2. The largest difference between the studied groups was found in the
      vertebral bodies and might support the use of transsacral or cement-augmented
      implants.
CI  - Copyright (c) 2016 by The Journal of Bone and Joint Surgery, Incorporated.
FAU - Wagner, Daniel
AU  - Wagner D
AD  - AO Research Institute Davos, Davos, Switzerland Department of Orthopaedics and
      Traumatology, University Medical Center Mainz, Mainz, Germany
      wagner.daniel@gmx.ch.
FAU - Kamer, Lukas
AU  - Kamer L
AD  - AO Research Institute Davos, Davos, Switzerland.
FAU - Sawaguchi, Takeshi
AU  - Sawaguchi T
AD  - Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal
      Hospital, Toyama, Japan.
FAU - Richards, R Geoff
AU  - Richards RG
AD  - AO Research Institute Davos, Davos, Switzerland.
FAU - Noser, Hansrudi
AU  - Noser H
AD  - AO Research Institute Davos, Davos, Switzerland.
FAU - Rommens, Pol M
AU  - Rommens PM
AD  - Department of Orthopaedics and Traumatology, University Medical Center Mainz,
      Mainz, Germany.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Bone Joint Surg Am
JT  - The Journal of bone and joint surgery. American volume
JID - 0014030
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Fractures, Bone/*etiology/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Models, Anatomic
MH  - Retrospective Studies
MH  - Sacrum/*diagnostic imaging/*injuries
MH  - *Tomography, X-Ray Computed
MH  - Young Adult
EDAT- 2016/04/08 06:00
MHDA- 2016/08/16 06:00
CRDT- 2016/04/08 06:00
PHST- 2016/04/08 06:00 [entrez]
PHST- 2016/04/08 06:00 [pubmed]
PHST- 2016/08/16 06:00 [medline]
AID - 98/7/584 [pii]
AID - 10.2106/JBJS.15.00726 [doi]
PST - ppublish
SO  - J Bone Joint Surg Am. 2016 Apr 6;98(7):584-90. doi: 10.2106/JBJS.15.00726.