• Friederike Klauke, Katja Zänker, Philipp Schenk, Philipp Kobbe, Christoph Muhl, and Thomas Mendel.
• Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Merseburger Straße 165, Halle, 06112, Germany. friederike.klauke@gmail.com.
• Eur J Trauma Emerg Surg. 2024 Aug 1; 50 (4): 176517731765-1773.

PurposePathogenesis of sacral fragility fractures is not fully understood. This study investigates zonal distribution of calcium salt and fat marrow in intact bone-healthy and osteoporotic pelvis. In addition, in unilateral sacral fractures, the fracture side was compared with the intact side.MethodsCT and MRI images of 37 pelves were analyzed. Zonal calcium salt distribution by Hounsfield units (HU) was recorded for each CT dataset. Fat marrow content was measured in MRI mDixon-Quant sequence. The cohort was divided: intact pelves with (PEO, HU < 100, n = 8) and without osteoporosis (PE, HU ≥ 100, n = 14) based on the mean HU value in LWK5. A third group consisted of patients with osteoporosis and unilateral fractures (PEOFx, n = 10).ConclusionThe results suggest that in PEO sacral alae experience disproportionate skeletal rarefaction. This concerns the sacral ala at the S1 level (- 25 ± 55), whereby the calcium salt content is so low that it corresponds to the S3 level of healthy bone (- 20 ± 21 HU). This explains the occurrence of transalar fractures in the load-transmitting zone S1. In PEOFx, the calcium salt density was higher and the fat content was lower on the fractured side than on the intact side, indicating bony compacting due to lateral compression and fat displacement due to hematoma in the accident mechanism. This study makes an important contribution to the understanding of the development of sacral fragility fractures. Furthermore, impaction of the cancellous bone within the fracture can be demonstrated.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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