FRACTURES OF THE SACRUM DUE TO BONE DEFIC IENCY - A METAANALYSIS OF 508 CASES

OBJECTIVES: Fractures of the sacrum due to bone deficiency are not ext remely uncommon although this cause has been overlooked for many years . We performed a meta-analysis of reported cases in order to determine the specific characteristics. METHOD: The characteristics of 493 case s of sacral fractures reported in the literature and those of 15 perso nal cases were studied. RESULTS: Most of the fractures occurred in wom en over 60 years of age. No trauma was identified in two-thirds of the cases. Clinical expression was not specific (back pain, sciatica, pel vic pain). Standard x-ray showed a fracture of the obturator frame in 38.8% of the cases but no direct or indirect signs of sacral fracture were seen in more than two-thirds of the cases. Tc99m scintigraphy had excellent sensitivity; a characteristic hyperfixation pattern forming an ''H'' was observed but only in 42.7% of the cases. Computed tomogr aphy had similar sensitivity and confirmed the diagnosis in doubtful c ases. Treatment was usually bed rest until satisfactory pain relief Of particular importance were neurological complications although they w ere exceptional. Several factors favoring sacral fracture were found, mainly osteoporosis and prior radiotherapy of the pelvis. CONCLUSION: Clinicians should be aware of this type of fracture which still remain s largely overlooked in geriatric care units.