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Comparative Study
. 2012 Jun;13(2):97-103.
doi: 10.1007/s10195-012-0182-2. Epub 2012 Mar 6.

Combined pubic rami and sacral osteoporotic fractures: a prospective study

M Alnaib  1 , S Waters, Y Shanshal, N Caplan, S Jones, A St Clair Gibson, D Kader
Affiliations
Comparative Study

Combined pubic rami and sacral osteoporotic fractures: a prospective study

M Alnaib et al. J Orthop Traumatol. 2012 Jun.

Abstract

Background: Pelvic osteoporotic fractures (POFs) are often associated with considerable morbidity and mortality mainly as a result of infections and cardiovascular events. Patients usually need prolonged institutionalization, rehabilitation, and follow-up, with a high rate of dependency and cost. The most common sites of POFs include the pubic rami, sacrum, ilium, and acetabulum. Combined pubic rami (PROFs) and sacral osteoporotic fractures (SOFs) have been reported, mostly in retrospective studies, describing the mechanism of injury and incidence. The aim of this study was to evaluate the association between PROFs and SOFs and to assess the effect of combined PROFs and SOFs on patients' mobility, discharge destination, and length of stay.

Materials and methods: We prospectively studied 67 patients with low-impact PROFs and/or SOFs. There were 54 (80.4%) female and 13 (19.6%) male patients, and the average age was 87.5 (range 65-96) years. All patients were assessed by the fracture liaison service. Patients had magnetic resonance imaging or bone scan when there was history of low back pain following the injury or lumbosacral tenderness on clinical examination.

Results: The mean length of stay for all patients was 45 (± 35) days. Mortality rate was 10.4%. A significant relationship was found between low back pain and a positive finding of sacral fracture. Patients with combined PROFs and SOFs showed significantly longer length of stay than those with isolated PROFs.

Conclusions: The presence of low back pain and tenderness in patients who had low-impact pelvic injuries was highly suggestive of the presence of an associated SOF. There was a high association between sacral and PROFs. The length of stay of patients with PROFs associated with sacral osteoporotic fractures was significantly longer than that of patients with PROFs only. Therefore, we recommend considering the high association between SOFs and PROFs in planning the management and rehabilitation of patients with POFs.

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Figures

Fig. 1
Fig. 1
a Anteroposterior radiograph of pelvis of an 84-year-old woman with back pain showing right superior and inferior pubic rami fractures. b Coronal T1-weighted magnetic resonance image scan of same patient showing sacral osteoporotic fracture
Fig. 2
Fig. 2
Percentage of patients with either one or two pubic rami fractures as a function of age, as well as the percentage of patients with associated sacral fractures
Fig. 3
Fig. 3
Mean (±standard deviation) length of stay in hospital as a function of age
See this image and copyright information in PMC

References

    1. Dasgupta B, Shah N, Brown H, Gordon TE, Tanqueray AB, Mellor JA. Sacral insufficiency fractures: an unsuspected cause of low back pain. Br J Rheumatol. 1998;37:789–793. doi: 10.1093/rheumatology/37.7.789. - DOI - PubMed
    1. Schapira D, Militeanu D, Israel O, Scharf Y. Insufficiency fractures of the pubic ramus. Semin Arthritis Rheum. 1996;25:373–382. doi: 10.1016/S0049-0172(96)80002-3. - DOI - PubMed
    1. Kannus P, Palvanen M, Parkkari J, Niemi S, Jarvinen M. Osteoporotic pelvic fractures in elderly women. Osteoporos Int. 2005;16:1304–1305. doi: 10.1007/s00198-005-1941-1. - DOI - PubMed
    1. Peris P, Guanabens N, Pons F, Herranz R, Monegal A, Suris X, Munoz-Gomez J. Clinical evolution of sacral stress fractures: influence of additional pelvic fractures. Ann Rheum Dis. 1993;52:545–547. doi: 10.1136/ard.52.7.545. - DOI - PMC - PubMed
    1. Rapp K, Cameron ID, Kurrle S, Klenk J, Kleiner A, Heinrich S, Konig HH, Becker C (2010) Excess mortality after pelvic fractures in institutionalized older people. Osteoporos Int 21:1835–1839 - PubMed

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