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Comparison of the zonal distribution of calcium salt density and fat marrow in bone-healthy and osteoporotic sacra: an image data analysis using quantitative computed tomography and magnetic resonance imaging

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Pathogenesis 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.

Methods

CT 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).

Conclusion

The 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.

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Data Availability

No datasets were generated or analysed during the current study.

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Authors and Affiliations

  1. University Hospital Halle, Martin Luther University Halle-Wittenberg, Department Trauma Surgery, 06120, Halle, Germany

    Friederike Klauke

  2. Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Halle, Germany

    Friederike Klauke

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Contributions

F.K. and T.M. developed the concept of the research project and wrote the manuscript. P.S. created the illustrations and carried out the statistics. K.Z. worked on the collection, procurement and provision of the data. P.K. interpreted the data with regard to the current state of knowledge. C.M. worked on the provision of the data. All authors reviewed the manuscript.

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Correspondence to Friederike Klauke.

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Klauke, F. Comparison of the zonal distribution of calcium salt density and fat marrow in bone-healthy and osteoporotic sacra: an image data analysis using quantitative computed tomography and magnetic resonance imaging. Eur J Trauma Emerg Surg (2024). https://doi.org/10.1007/s00068-024-02507-w

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  • DOI: https://doi.org/10.1007/s00068-024-02507-w

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