Pelvic insufficiency fractures
Updates to Article Attributes
Pelvic insufficiency fractures are a relatively common subtype of insufficiency fracture, and are recognised as a major cause of low back, buttock and groin pain in susceptible populations.
Epidemiology
Senile/postmenopausal osteoporosis is the most common predisposing factor. Other important risk factors include:
- renal failure
- rheumatoid arthritis
- extended corticosteroid use
- history of radiation therapy
- mechanical changes after hip arthroplasty
Clinical presentation
Patients most frequently present with a history of minor trauma or an insidious onset of pain in the above noted locations.
Radiographic features
Plain film, MRI and scintigraphic appearance at the site of fracture are the same as with all insufficiency fractures. They often occur in characteristic locations and patterns within the pelvis, and are best detected and evaluated using bone scintigraphy and/or MRI. CT is a relatively insensitive method of detection. Pelvic insufficiency fractures are typically occult on plain film unless secondary remodelling has begun.
Common locations include:
- sacrum: (sacral insufficiency fracture) usually vertically through the sacral ala, paralleling the sacroiliac joint, often with a transverse component - this pattern resembles the capital letter H, leading to the designation H sign (or Honda sign)
- medial iliac: vertical fracture paralleling the sacroiliac joint
- supra-acetabular region: about 1/3are associated with sacral insufficiency fractures
- iliac wing: oblique fracture through the iliac wing, oriented somewhat parallel to the iliac crest
- pubic rami: nearly 90% of fractures at this site occur in conjunction with insufficiency fractures elsewhere within the pelvis
- parasymphyseal: (parasymphyseal insufficiency fracture 4,5) also frequently associated with other pelvic insufficiency fractures
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