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The Denis Classification System classified sacral fractures into three regions according to the part of the bone affected. The location of the fracture has a major influence on symptoms experienced. [3] [4] Zone 1 , may cause disruption to the nerve root of the fifth lumbar vertebra (L5) Zone 2 (sacral foramina), may cause sciatica
Pelvic, sacral, and proximal femoral fractures are of increasing significance especially with the aging of the population. [1] Figure 12: Right sacral alar insufficiency fracture in a 29-year-old woman with a 9-year history of corticosteroid therapy for systemic lupus erythematous. Conventional radiographs showed normal appearance (not shown).
The "Honda sign" (H-pattern [1]) is a radiologic sign seen in case of sacral insufficiency fracture in bilateral sacral insufficiency fractures on a radioisotope bone scan. [2] It gets its name because the shape observed resembles the logo of the Honda motor company, resembling the alphabet "H".
The sacroiliac joint is a true diarthrodial joint that joins the sacrum to the pelvis. [1] [8] [16] [17] The sacrum connects on the right and left sides to the ilia (pelvic bones) to form the sacroiliac joints. The pelvic girdle is made up of two innominate bones (the iliac bones) and the sacrum.
A pelvic fracture is a break of the bony structure of the pelvis. [1] This includes any break of the sacrum, hip bones (ischium, pubis, ilium), or tailbone. [1] Symptoms include pain, particularly with movement. [1] Complications may include internal bleeding, injury to the bladder, or vaginal trauma. [2] [3]
Sacral insufficiency fractures are an infrequent but often disabling cause of severe low back pain. At times, the pain can be so severe that it may cause the patients to become bedridden, placing them at risk for complications of immobility such as deep vein thrombosis, pulmonary emboli, muscle atrophy, decubitus ulcers, and bone demineralization.
Bertolotti's syndrome is characterized by sacralization of the lowest lumbar vertebral body and lumbarization of the uppermost sacral segment. It involves a total or partial unilateral or bilateral fusion of the transverse process of the lowest lumbar vertebra to the sacrum, leading to the formation of a transitional 5th lumbar vertebra.
While nonsurgical treatments are effective for some, others have found that surgery for the dysfunctional sacroiliac joint is the only method to relieve pain. Sacroiliac joint dysfunction is diagnosed by a physician. Associated surgery should only occur when certain criteria are satisfied. [1]