Assessment of regional sacral bone quality: A step towards patient-specific fracture fixation.

bone mineral density fracture fixation quantitative CT sacrum

Journal

Journal of orthopaedic research : official publication of the Orthopaedic Research Society
ISSN: 1554-527X
Titre abrégé: J Orthop Res
Pays: United States
ID NLM: 8404726

Informations de publication

Date de publication:
01 2023
Historique:
revised: 07 01 2022
received: 18 06 2021
accepted: 13 03 2022
pubmed: 18 3 2022
medline: 15 12 2022
entrez: 17 3 2022
Statut: ppublish

Résumé

Characterizing changes in sacral bone density could help us to inform instrumentation choices for procedures involving the sacrum. The aim of this study is to provide detailed maps of changes in sacral bone density across a series of patients using opportunistic quantitative computed tomography (QCT). We hypothesized that there would be significant differences in local cortical and trabecular bone density associated with age and sex. Fifty-four three-dimensional sacral models were segmented from routine clinical computed tomography scans, and detailed bone density estimates were derived for each bone using a calibrated opportunistic QCT approach. The effects of age and sex on cortical and trabecular bone density were determined across the sample. Overall cortical bone loss averaged 2.1 and 0.9 mg/cc per year, and trabecular bone loss was 1.6 and 0.7 mg/cc for female and males, respectively. Several regions had loss rates several times greater. Areas that were significantly affected by age included the vertebral bodies, bilateral ala, apex, and areas adjacent to both the anterior and posterior sacral foramina. Areas that were significantly affected by sex were the anterior sacral promontory, aspects of the ala. Bone density distribution across the sacrum changes nonuniformly due to factors including sex and age. Despite these overall trends, there remains significant variability between individuals. Clinical significance: This study provides detailed bone density information for both cortical and trabecular bone that could assist orthopaedic surgeons in planning surgical approaches to sacral fracture fixation.

Identifiants

pubmed: 35299283
doi: 10.1002/jor.25329
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

141-149

Informations de copyright

© 2022 Orthopaedic Research Society. Published by Wiley Periodicals LLC.

Références

Breuil V, Roux CH, Carle GF. Pelvic fractures: epidemiology, consequences, and medical management. Curr Opin Rheumatol. 2016;28(4):442-447. doi:10.1097/BOR.0000000000000293
Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761-1767. doi:10.1016/S0140-6736(02)08657-9
Wagner D, Ossendorf C, Gruszka D, Hofmann A, Rommens PM. Fragility fractures of the sacrum: how to identify and when to treat surgically? Eur J Trauma Emerg Surg. 2015;41(4):349-362. doi:10.1007/s00068-015-0530-z
Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury. 2013;44(12):1733-1744. doi:10.1016/j.injury.2013.06.023
Bydon M, De la Garza-Ramos R, Macki M, Desai A, Gokaslan AK, Bydon A. Incidence of sacral fractures and in-hospital postoperative complications in the United States: an analysis of 2002-2011 data. Spine. 2014;39(18):E1103-E1109. doi:10.1097/BRS.0000000000000448
Weber M, Hasler P, Gerber H. Insufficiency fractures of the sacrum. Twenty cases and review of the literature. Spine. 1993;18(16):2507-2512. doi:10.1097/00007632-199312000-00021
Reuther G, Röhner U, Will T, Dehne I, Petereit U. CT-guided screw fixation of vertical sacral fractures in local anaesthesia using a standard CT. Rofo. 2014;186(12):1134-1139. doi:10.1055/s-0034-1366605
Kraemer W, Hearn T, Tile M, Powell J. The effect of thread length and location on extraction strengths of iliosacral lag screws. Injury. 1994;25(1):5-9. doi:10.1016/0020-1383(94)90176-7
Smith SA, Abitbol JJ, Carlson GD, Anderson DR, Taggart KW, Garfin SR. The effects of depth of penetration, screw orientation, and bone density on sacral screw fixation. Spine. 1993;18(8):1006-1010. doi:10.1097/00007632-199306150-00009
Andrich S, Haastert B, Neuhaus E, et al. Excess mortality after pelvic fractures among older people. J Bone Miner Res. 2017;32(9):1789-1801. doi:10.1002/jbmr.3116
Mears SC, Berry DJ. Outcomes of displaced and nondisplaced pelvic and sacral fractures in elderly adults. J Am Geriatr Soc. 2011;59(7):1309-1312. doi:10.1111/j.1532-5415.2011.03455.x
Seebeck J, Goldhahn J, Städele H, Messmer P, Morlock MM, Schneider E. Effect of cortical thickness and cancellous bone density on the holding strength of internal fixator screws. J Orthop Res. 2004;22(6):1237-1242. doi:10.1016/j.orthres.2004.04.001
Strømsøe K, Kok WL, Høiseth A, Alho A. Holding power of the 4.5 mm AO/ASIF cortex screw in cortical bone in relation to bone mineral. Injury. 1993;24(10):656-659.
Lee SJ, Binkley N, Lubner MG, Bruce RJ, Ziemlewicz TJ, Pickhardt PJ. Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density. Osteoporos Int. 2016;27(3):1131-1136. doi:10.1007/s00198-015-3318-4
Ziemlewicz TJ, Maciejewski A, Binkley N, Brett AD, Brown JK, Pickhardt PJ. Opportunistic quantitative CT bone mineral density measurement at the proximal femur using routine contrast-enhanced scans: direct comparison with DXA in 355 adults. J Bone Miner Res. 2016;31(10):1835-1840. doi:10.1002/jbmr.2856
Telfer S, Brunnquell CL, Allen JD, Linnau KF, Zamora D, Kleweno CP. The effect of age and sex on pelvic bone density measured opportunistically in clinical CT scans. J Orthop Res. 2020;39:485-492. doi:10.1002/jor.24792
Fedorov A, Beichel R, Kalpathy-Cramer J, et al. 3D slicer as an image computing platform for the quantitative imaging network. Magn Reson Imaging. 2012;30(9):1323-1341. doi:10.1016/j.mri.2012.05.001
Adams D, Collyer M, Kaliontzopoulou A, Baken E. Geomorph: geometric morphometric analyses of 2D/3D landmark data. 2021. Accessed January 27, 2021. https://CRAN.R-project.org/package=geomorph
Whitcher B, Schmid VJ, Thorton A. Working with the DICOM and NIfTI data standards in R. J Stat Softw. 2011;44(1):1-29. doi:10.18637/jss.v044.i06
Matsukawa K, Yato Y, Hynes RA, et al. Comparison of pedicle screw fixation strength among different transpedicular trajectories: a finite element study. Clin Spine Surg. 2017;30(7):301-307. doi:10.1097/BSD.0000000000000258
Bainbridge KE, Sowers MF, Crutchfield M, Lin X, Jannausch M, Harlow SD. Natural history of bone loss over 6 years among premenopausal and early postmenopausal women. Am J Epidemiol. 2002;156(5):410-417. doi:10.1093/aje/kwf049

Auteurs

Simran Mand (S)

Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA.

Scott Telfer (S)

Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA.

Shamele Battan (S)

Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA.

Christina L Brunnquell (CL)

Department of Radiology, University of Washington, Seattle, Washington, USA.

Ken F Linnau (KF)

Department of Radiology, University of Washington, Seattle, Washington, USA.

David Zamora (D)

Department of Radiology, University of Washington, Seattle, Washington, USA.

Conor P Kleweno (CP)

Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH