Review Article

Skeletal Radiology

, Volume 39, Issue 2, pp 117-130

First online:

Percutaneous treatment of insufficiency fractures

Principles, technique and review of literature
  • Douglas P. BeallAffiliated withUniversity of Oklahoma Health Science CenterClinical Radiology of Oklahoma Email author 
  • , Abhijit DatirAffiliated withDepartment of Radiology, Royal National Orthopaedic Hospital
  • , Sharon L. D’SouzaAffiliated withUniversity of Oklahoma Health Science Center
  • , Logan S. D’SouzaAffiliated withUniversity of Oklahoma Health Science Center
  • , Divya GundaAffiliated withUniversity of Oklahoma Health Science Center
  • , John MorelliAffiliated withUniversity of Oklahoma Health Science Center
  • , Michael Brandon JohnsonAffiliated withUniversity of Oklahoma Health Science Center
  • , Nima NabavizadehAffiliated withUniversity of Oklahoma Health Science Center

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Insufficiency fractures of the pelvis, sacrum, spine, and long bones are painful, debilitating, and are common consequences of osteoporosis. Conventional treatment for these fractures varies from conservative therapy to surgery with plate and screw fixation. The former fails to address the underlying problem of fracture and frequently does not alleviate symptoms, while the latter is invasive and not always possible in older populations with low bone density and numerous co-morbidities. Osseous augmentation with polymethylmethacrylate (PMMA) has been used for over two decades to treat fractures related to osteoporosis, but has not been commonly used to treat fractures outside of the vertebral bodies. Osseous augmentation with PMMA is an image-guided procedure and various techniques have been utilized to treat fracture in different locations. We describe various techniques for image-guided osseous augmentation and treatment of insufficiency fractures with bothPMMA and allograft bone for fractures of the pelvis including sacrum, acetabulum, pubic symphysis, pubic rami ilium; appendicular skeleton including distal radius, proximal femur, and vertebral body. We also describe the potential risks and complications associated with percutaneous treatment of insufficiency fractures and techniques to avoid the pitfalls of the various procedures. We will present the process for patient follow-up and data regarding the pre- and postprocedure pain response in patients undergoing treatment for pelvic insufficiency fractures.


Vertebroplasty Kyphoplasty Spineoplasty Augmentation Polymethylmethacrylate