IMAGING OF PELVIC INSUFFICIENCY FRACTURES

Insufficiency fractures of the pelvis are being increasingly recognize d as a major cause of low back pain in elderly women with osteoporosis , Fractures in the sacrum are difficult to diagnose, as plain radiogra phic findings are either unhelpful or misleading, Bone scintigraphy is very sensitive for the detection of fractures in the sacrum, with dem onstration of the H-shaped (or butterfly) sacral pattern or the combin ation of concomitant sacral and parasymphyseal uptake being considered as characteristic of insufficiency fractures, Computed tomography (CT ) is helpful for confirming the presence of fractures in cases with at ypical scintigraphic patterns, particularly in those with a known prim ary malignant neoplasm. CT is especially useful in the further evaluat ion of parasymphyseal and pubic rami lesions, The majority of patients respond well to periods of enforced bed rest and administration of an algesics, Recognition of the spectrum of imaging findings for this ent ity should lead to its correct identification and the institution of a ppropriate treatment.