Osteoporotic Insufficiency Research Articles

Pelvic insufficiency fracture in an osteoporotic 47-year-old female: a case report

Insufficiency fractures (IFs) represent a form of stress fractures frequently linked to osteoporosis and a lack of vitamin D. These fractures, which are not caused by trauma, typically manifest in the pelvis and spine, although occurrences in atypical locations are also relatively frequent. The primary methods for diagnosing IF involve using plain radiographs and magnetic resonance imaging scans, which are commonly employed imaging techniques. The management involves both medical and surgical methods, tailored as per the needs of the patient. 47-year-old female patient presented to the outpatient department with complaints of low back ache with waddling gait, with pain not responding to analgesics. Laboratory and radiological assessment revealed osteoporotic Insufficiency fracture in the pelvis which was managed with both surgical and medical methods, with surgical management involving percutaneous screw fixation of the fractures. Diagnosis of the osteoporotic insufficiency fractures at atypical locations can be extremely challenging because of the inconclusive radiographs and the lack of a perceptible trauma history and hence, can be missed at the initial presentation. The management includes both operative and non-operative modalities, best tailored as per the patient needs and expectations.

TECHNIQUES OF MINIMALLY INVASIVE SURGERY IN ADULT DEGENERATIVE SPINAL DEFORMITY : A SYSTEMATIC REVIEW

Adult spinal deformities are a leading cause of pain and disability in the modern world. Advances in modern healthcare has allowed the population’s life expectancy to increase substantially. Despite this, there has been a marked increase in the number of ill and disabled individuals, leading to impairment in their quality of life. In order to continue performing successfully as an adult beyond retirement age, it is imperative to avoid pain and limitations in physical activity. When an adult develops a spinal deformity, surgery can help alleviate pain and reduce disability. Adult scoliosis is defined as a spine curvature greater than 10 degrees in a patient older than 18 years; nevertheless, in more severe cases, treatment is sometimes advised. Degeneration may be accelerated by asymmetric disk/facet degeneration or osteoporotic insufficiency fractures. Recently, minimally invasive spine surgery (MIS) has been at the forefront of innovation in spine surgery. MIS spine surgery not only refers to surgery through a smaller incision, but also to a technique that strives to reduce the approach-related morbidity associated with conventional open spine surgery. According to the findings of this study, Surgeons have to be prepared to offer both open or MIS for patients. Various MIS technique and its combination including hybrid surgery are used in cases of adult spinal deformity, the appropriate technique chosen for the surgery should include factors such as the spinopelvic harmony, age and outcome prediction of each patients into consideration as each technique has its own advantages and disadvantages.

Insufficiency fractures of the spine in relation to cancellous bone density : An in vitro study

HintergrundDas Risiko für osteoporotische Insuffizienzfrakturen (Fx) am Achsenskelett steigt mit zunehmender Abnahme der Knochendichte, wobei sich thorakal und thorakolumbal eine Häufung findet. Um die unterschiedliche Verteilung von Fx entlang der Wirbelsäule (WS) besser zu verstehen, wurden morphologische und osteodensitometrische Untersuchungen mittels Computertomographie (CT) in den verschiedenen WS-Abschnitten durchgeführt. Zudem war zu klären, ob die bei CT-Untersuchungen aus anderen Indikationen gefunden Hounsfield-Einheiten (HE) mit der Knochendichte korrelieren und Anlass für eine osteologische Diagnostik sein könnten.Material und MethodenVon 26 Körperspenden wurden die gesamten WS in einem Plexiglas-Wasser-Phantom fixiert und mittels hochauflösende Spiral-CT analysiert. Zusätzlich erfolgte die Messung der CT-morphologischen Spongiosadichte in HE von C3 bis S2 (624 Wirbelkörper). Der Knochenmineralgehalt (KMG, mg/ml) wurde ermittelt und zur Abschätzung einer Osteoporose (OPO) herangezogen.ErgebnisseBei allen WS lag eine OPO vor. Bei einem KMG unterhalb von 60 mg/ml fanden sich signifikant vermehrte Sinterungsfrakturen im thorakalen und thorakolumbalen Bereich. Osteoporotische Insuffizienzfrakturen im HWS-Bereich fanden sich insgesamt nicht. Die Spongiosadichte war signifikant höher in den zervikalen (Median 188,6 HE) als in den lumbalen (Median 63,6 HE) und sakralen (Median 25,5 HE) Wirbelkörpern aller untersuchten WS.SchlussfolgerungEin KMG-Verlust der Wirbelkörperspongiosa führt zu einem erhöhten Fx-Risiko, welches sich auch bei den verwendeten WS findet. Jedoch wird im zervikalen Bereich ein scheinbarer Schwellenwert für das Auftreten von Sinterungsfrakturen nicht unterschritten. Einen Schwellenwert für HE zu finden, wäre für die klinische Praxis relevant.

Combination of long- and short-axis alar sacroplasty techniques under fluoroscopic guidance for osteoporotic sacral insufficiency fracture

BackgroundSacral insufficiency fracture (SIF) is rarer than osteoporotic vertebral compression fracture that occurs at other levels of the thoracolumbar spine. Percutaneous sacroplasty can effectively relieve pain and improve mobility. Several sacroplasty-based techniques have been reported to date.Sacroplasty is often performed with computed tomography-guided cannula placement, which is time intensive and results in greater radiation exposure than that resulting from fluoroscopy. Herein, we report our preliminary experience with a combination of long- and short-axis alar sacroplasty techniques under fluoroscopic guidance for osteoporotic SIFs.MethodsWe retrospectively reviewed 44 consecutive patients with symptomatic osteoporotic SIFs who underwent alar sacroplasty between January 2013 and February 2020. The study group comprised 19 patients who underwent a combination of long- and short-axis alar sacroplasty techniques under fluoroscopic guidance. The control group comprised the remaining 25 patients who underwent short-axis alar sacroplasty under fluoroscopic guidance. Visual analog scale (VAS) scores, operation times, injected cement volumes, and postoperative complications were recorded.ResultsThe VAS score for pain decreased in both groups; however, no significant difference was noted between the study and control groups in injected cement volume (3.55 ± 0.96 vs 2.94 ± 0.89 mL). The operation time was longer in the study group than in the control group (32 ± 7.1 vs 28.04 ± 4.99 min; P = 0.046). No major complications were noted.ConclusionA combination of long- and short-axis alar sacroplasty techniques can be effectively performed under fluoroscopic guidance for osteoporotic SIFs.

Balloon-assisted sacroplasty as a successful procedure for osteoporotic sacral insufficiency fractures after failure of the conservative treatment

Osteoporotic vertebral fractures without prior adequate traumatization are frequent diagnosed in orthopedics because of the increasing life expectancy and incidence of osteoporosis. The associated high mortality is caused by reduced mobilization which leads to a higher risk of infection and a bedridden state. On the other hand the diagnosis of sacral insufficiency fractures is often prolonged because of unspecific symptoms while being associated with similar risks. This article presents an overview of the present scientific literature and a retrospective analysis of patients treated via balloon-assisted sacroplasty. In 8 years, ten patients (three men and seven women) were treated. The average age was 78.4 years and the average time until the diagnosis 4.6 weeks. In most patients a significant pain reduction after the failure of conservative treatment thanks to operative treatment as well as increased mobility was observed. Only one experienced a minor surgical complication being cement leakage with nerval impaction which did not compromise her clinical outcome or satisfaction with the procedure. Balloon-assisted sacroplasty can possibly be seen as an effective symptomatic therapy in osteoporotic insufficiency fractures.

Radiologic diagnosis of pathologic fractures

Pathologic fractures are fractures that occur without an adequate traumatic event due to focal benign or malignant skeletal lesions. The most common causes of pathologic fractures are cystic bone lesions, plasmocytoma or multiple myeloma, and the development of osseous metastases, which is increasing due to an aging general population and advances in cancer treatment. The differentiation of pathologic fractures from stress fractures, especially osteoporotic insufficiency fractures is crucial for correct treatment planning. This review intends to explain the imaging characteristics of pathologic fractures. Moreover, it explains the role of imaging when pathologic fractures are suspected. In addition, the Mirels' score and the SINS (Spinal Instability Neoplastic Score), which are powerful yet easy-to-use tools for the assessment of the fracture risk of benign or malignant bony lesions of the extremities and the vertebral column, shall be introduced. APubMed literature search with the following terms was conducted: "pathologic fracture", "fatigue fracture", "insufficiency fracture", "treatment of pathologic fractures", "imaging of pathologic fractures", "fracture risk", "bone metastases", "MRI of pathologic fractures", "CT of pathologic fractures", "differentiation of pathologic and insufficiency fractures", "Mirels' score", "SINS" and "spinal instability neoplastic score". The definitions of pathologic, fatigue, and insufficiency fractures are explained. Moreover, the role of imaging in the clinical workup of suspected pathologic fractures and the differentiation of pathologic fractures from fatigue or insufficiency fractures as well as common scoring systems to assess the fracture risk of pathologic fractures are described.

Minimally invasive non-fusion vertebral body stabilization in severe benign and malignant fractures. Stent-screw Assisted Internal Fixation: the SAIF technique

This short review focuses on clinical and therapeutic issues posed by severe osteoporotic and neoplastic insufficiency vertebral fractures and on the potential use of a new technique to obtain minimally invasive vertebral body reconstruction, augmentation, and stabilization in such severe fractures, combining two preexisting procedures. The implant of vertebral body stents is followed by insertion of percutaneous, fenestrated, cement-augmented pedicular screws that act as anchors to the posterior elements for the cement–stent complex. This procedure results in a 360° nonfusion form of vertebral internal fixation that may empower vertebral augmentation and potentially avoid corpectomy in challenging osteoporotic and neoplastic fractures.

Comparison of the 18-month outcome after the treatment of osteoporotic insufficiency fractures by means of balloon sacroplasty (BSP) and radiofrequency sacroplasty (RFS) in comparison: a prospective randomised study

PurposeThe objective of this prospective, randomised study was to examine the feasibility and clinical outcome of balloon sacroplasty and radiofrequency sacroplasty.MethodsIn 40 patients with a total of 57 sacral fractures, CT-guided cement augmentation was performed by means of BSP or RFS. For BSP, the balloon catheter was inflated and deflated in the fracture zone, and the hollow space, thus, created was then filled with PMMA cement. For RFS, the spongious space in the fracture zone was initially extended using a flexible osteotome, and the highly viscous PMMA cement, activated by radiofrequency, was then inserted into the prepared fracture zone. Pain intensity was determined on a VAS before the intervention, on the second day, and 6, 12 and 18 months after the intervention. The results were tested for significance by means of paired Wilcoxon rank-sum tests and Mann–Whitney U tests.ResultsBSP and RFS were technically fully feasible in all patients. An average of 6.3 ml cement per fracture was inserted in the BSP group and an average of 6.1 ml per fracture in the RFS group. Leakage could be ruled out for both procedures. The mean pain score on the VAS before the intervention was 8.6 ± 0.55 in the BSP group and 8.8 ± 0.58 in the RFS group. On the second postoperative day, a significant pain reduction was seen (p < 0.001), with an average value of 2.5 (BSP ± 0.28, RFS ± 0.38) for both groups. After 6 (12; 18) months, these values were stable for the BSP group at 2.3 ± 0.27 (2.3 ± 0.24; 2.0 ± 0.34) and for the RFS group at 2.4 ± 0.34 (2.2 ± 0.26; 2.0 ± 0.31). With regard to pain, exceedance probability values of p = 0.86 (6 months), p = 0.94 (12 months) and p = 1 (18 months) were seen, so that neither treatment method leads to differences in results.ConclusionsBSP and RFS are interventional, minimally invasive procedures that enable reliable cement augmentation and achieve equally good clinical outcomes in the medium term.

Percutaneous sacroplasty for sacral fracture by osteoporotic insufficiency

Percutaneous sacroplasty for sacral fracture by osteoporotic insufficiency

Radiofrequency sacroplasty (RFS) for the treatment of osteoporotic insufficiency fractures

In elderly patients with reduced bone quality, insufficiency fractures of the sacrum are relatively common and are typically accompanied by severe, disabling pain. The objective of this study was to evaluate the feasibility of cement augmentation by RFS, as well as to determine postinterventional leakages and present the patients' outcomes. In 20 patients (18 women, 2 men) with an average age of 80.4 (65-92) years, a fracture of the sacrum was detected by CT and MRI. Clinically manifest osteoporosis with QCT values of below 50 mg/ml was found in all patients. An initially performed conservative treatment over a period of 3 weeks did not achieve a satisfactory reduction in the severe, disabling pain. The cement augmentation was performed under CT guidance by means of RFS under intubation anaesthesia. A Jamshidi needle was advanced into the respective fracture zone in the sacrum from dorsal to ventral (short axis) or from lateral to medial transiliac (transiliac axis). After removing the inner needle, a flexible osteotome was inserted through the positioned hollow needle and used to extend the spongious space in the fracture zone and thus prepare a cavity for the cement filling. The highly viscous polymethyl methacrylate (PMMA) cement, activated by radiofrequency, was then inserted into the prepared fracture zone through a substituted screw cannula. Cement filling was performed discontinuously under instrumental guidance at 1.3 ml/min under CT guidance. Cement leakages were determined in CT images and conventional X-rays on the day after the intervention. Pain was documented on a visual analogue scale (VAS) on the day before the intervention, on the second day, and after 6 and 12 months after the intervention. Additionally occurring complications were recorded, and the patients were asked to state how satisfied they were after 12 months. RFS was technically feasible in all patients. In the control CT scans and X-rays, sufficient cement distribution and interlocking with vital bone was found along the course of the fracture in the sacrum. 7.2 (4-9) ml of cement were inserted per fracture. Leakage could be ruled out. The mean pain score on the VAS was 8.8 ± 1.2 before the intervention, and a significant reduction in pain (p < 0.001) was seen on the second postoperative day, with an average value of 2.3 ± 0.7, which was stable at 2.2 ± 1.3 after 6 months and 2.1 ± 1.1 after 12 months. All of the patients could be fully re-mobilised and discharged back home. A high level of patient satisfaction was found after 12 months, with 18 of the 20 patients stating that they would undergo the intervention again. One patient died of a stroke, another of cancer over the course. As a minimally invasive procedure, RFS is an effective and safe method of treatment for rapid, significant and sustained pain reduction.

Safety and effectiveness of sacroplasty: a large single-center experience.

Sacral insufficiency fractures are a common cause of severe low back pain and immobilization in patients with osteoporosis or cancer. Current practice guideline recommendations range from analgesia and physical therapy to resection with surgical fixation. We sought to assess the safety and effectiveness of sacroplasty, an emerging minimally invasive treatment. We performed a retrospective review of institutional databases for percutaneous sacroplasty performed between January 2004 and September 2013. Demographic and procedural data and pre- and posttreatment Visual Analog Scale, Functional Mobility Scale, and Analgesic Scale scores were reviewed. Overall response was rated by using a 4-point scale (1, complete resolution of pain; 2, improvement of pain; 3, no change; 4, worsened pain) assessed at short-term follow-up. Fifty-three patients were included; most (83%) were female. Fracture etiology was cancer-related (55%), osteoporotic insufficiency (30%), and minor trauma (15%). No major complication or procedure-related morbidity occurred. There were statistically significant decreases in the Visual Analog Scale (P < .001), Functional Mobility Scale (P < .001), and Analgesic Scale scores (P < .01) in 27 patients with recorded data: pretreatment Visual Analog Scale (median [interquartile range], 9.0 [8.0-10.0]); Functional Mobility Scale, 3.0 (2.0-3.0); and Analgesic Scale scores, 3.0 (3.0-4.0) were reduced to 3.0 (0.0-5.8), 1.0 (0.25-2.8), and 3.0 (2.0-3.8) posttreatment. When we used the overall 4-point score at a mean of 27 days, 93% (n = 45) reported complete resolution or improvement in overall pain. In this single-center cohort, sacroplasty was a safe and effective procedure. There were significant short-term gains in pain relief, increased mobility, and decreased dependence on pain medication.

Percutaneous sacroplasty using CT guidance for pain palliation in sacral insufficiency fractures

Background and objectiveSacroplasty has emerged as a treatment option for patients with painful osteoporotic sacral insufficiency fractures. We report short-term outcomes in a consecutive cohort of patients treated with sacroplasty.MethodsWe...

The record of onychomadesis

A 79-year-old woman presented with nail abnormalities on her right hand. She had hepatitis B liver cirrhosis and osteoporosis. Physical examination reviewed the onychomadesis of the index, middle and ring fingers of her right hand. History reviewed that the patient was admitted 2 months previously because of osteoporotic insufficiency pelvic fracture and cellulitis on her right foot. There was no history of traumatic injury to her fingers. Fungal smear and nail culture were negative. Over the next few weeks, the fingernails involved grew out. It was likely that systemic stress due to cellulitis caused the onychomadesis.

Association between degenerative spondylolisthesis and spinous process fracture after interspinous process spacer surgery

Spinous process fracture is a recognized complication associated with interspinous process spacer (IPS) surgery. Although occasionally identified by plain radiographs, computed tomography (CT) appears to identify a higher rate of such fractures. Although osteoporotic insufficiency fracture is considered a contraindication for IPS surgery, a formal risk factor analysis for this complication has not previously been reported. To identify risk factor(s) associated with early spinous process fracture after IPS surgery. Prospective cohort study of 39 consecutive patients with lumbar stenosis and neurogenic claudication undergoing IPS surgery at a single institution. Patients underwent preoperative dual-energy X-ray absorptiometry (DXA) scans, lumbar spine CT, and plain radiographs. Postoperatively, patients underwent repeat CT imaging within 6 months of surgery and serial radiographs at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. Preoperative CT scans were analyzed by calculating average Hounsfield units for a 1 cm(2) area of the midsagittal reconstructed image for four separate locations: midvertebral body, subcortical bone subjacent to the superior margin of the midspinous process, subcortical bone above the inferior margin of the midspinous process, and the midspinous process. Thirty-eight patients underwent IPS surgery at a total of 50 levels (38 L4-L5, 12 L3-L4; 26 one-level, 12 two-level). One patient underwent laminectomy at index surgery and was excluded from the analysis. Implants included 34 titanium X-STOP (Medtronic, Memphis, TN, USA), 8 polyaryletheretherketone X-STOP (Medtronic, Memphis, TN, USA), and 8 Aspen (Lanx, Broomfield, CO, USA) devices. Eleven spinous process fractures were identified by CT in 11 patients (22.0% of levels). No fractures were apparent on plain radiographs. The rate of spondylolisthesis observed on preoperative radiographs was 100% (11 of 11) among patients with fractures compared with 33.3% (9 of 27) of patients without fracture (p=.0001). Overall, 21 of 39 patients in this series had spondylolisthesis, and the rate of fracture in this group was 52%. Among patients without spondylolisthesis, the fracture rate was 0%. A trend was observed toward decreased DXA lumbar spine and hip T-scores among fracture patients versus nonfracture patients (0.2 ± 1.7 vs. 0.8 ± 1.7; p=.389; -1.1 ± 1.4 vs. -0.3 ± 1.4; p=.201), but these differences were not significant. Similarly, bone density based on CT measurements at four different locations revealed a trend toward decreased density among fracture patients, but these differences were not significant. Degenerative spondylolisthesis appears strongly associated with the occurrence of spinous process fracture after IPS surgery. There is a trend toward increased fracture risk in patients with decreased bone mineral density as measured by both DXA scan and CT-based volume averaging of Hounsfield units, but osteoporosis appears to be a relatively weaker risk factor. The association between spondylolisthesis and fracture observed in this study may account for the relatively poorer outcome of IPS surgery in patients with spondylolisthesis that has been reported in previous series.

Bladder rupture following osteoporotic pubic ramus and sacral insufficiency fractures

We present a case report of an 86-year-old lady with pubic ramus and sacral insufficiency fractures who developed extra-vesical bladder rupture following displacement of the pubic ramus fracture, a very unusual complication.

Value of MRI imaging prior to a kyphoplasty for osteoporotic insufficiency fractures.

Previous studies have shown the safety and effectiveness of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures (OVCFs). MRI and particularly the short tau inversion recovery (STIR) sequence are very sensitive for detecting vertebral edema as a result of fresh fractures or micro-fractures. Therefore, it has a great therapeutic relevance in differentiating vertebral deformities seen by conventional X-ray and CT scans. Although an MRI scan is expensive, to my knowledge no study has evaluated the benefits of preoperative MRI in evaluating a therapeutic plan for kyphoplasty. This is a prospective study evaluating the benefit of a preoperative MRI scan regarding changes of kyphoplasty therapy. Twenty-eight patients were included in this study. Twenty-four patients were treated by balloon kyphoplasty, in a total of 40 vertebral bodies. The mean age was 73 years. All patients suffered from OVCFs. As a first step, all patients got a CT scan. The individual therapeutic plan was then defined by the patients' history, complaints and the results of the CT scan. As far as all criteria for kyphoplasty were fulfilled, an MRI examination including the STIR sequences was performed preoperatively. The number of times a change was made in therapy as a result from the additional information from the MRI was then evaluated. By performing a preoperatively MRI examination, the therapy plan was changed in 16 out of 28 (57%) patients. Eight patients underwent additional levels of kyphoplasty at the same procedure. In five patients, lesions were found to be old fractures and therefore were not treated operatively. Two of these patients received no kyphoplasty at all. Another patient only a part of the originally intended levels was treated. The other two cases received a kyphoplasty at different vertebral levels, as these vertebral bodies showed signs of an acute fracture in the MRI scan. Additionally, an incidental diagnosis of carcinoma of the kidney was made in two patients. Kyphoplasty was deferred and they were referred for further evaluation. One patient was found to have an aortic aneurysm. Kyphoplasty was performed and after that the patient was referred in order to treat the aneurysm. This study confirms the diagnostic benefits of an MRI scan before performing a kyphoplasty. For 16 out of 28 patients, the therapeutic plan was changed because of the information obtained by preoperative MRI. Preoperative MRI helped to generate the correct surgical strategy, by demonstrating the correct location of injury and by detecting concomitant diseases.

Computer Assisted Percutaneous Placement of Augmented Iliosacral Screws

A technical report of fluoroscopy guided placement of augmented iliosacral screws in osteoporotic insufficiency fractures of the sacrum. To describe a combined approach of navigated iliosacral screw placement and screw augmentation as an option for osteosynthesis of sacral insufficiency fractures in the elderly. The incidence of sacral insufficiency fractures is increasing. Outcome of conservative treatment is inconsistent. Recently sacroplasty is propagated as an interventional therapy but the long-term outcome is still unknown. Evidence from finite element models suggests that stabilization of the sacrum achieved by sacroplasty is insufficient to restore the weight bearing capacity of the sacrum permanently. We suggest a minimally invasive fluoroscopically navigated iliosacral screw osteosynthesis with cement augmentation of the screws for treatment of insufficiency fractures of the sacrum. The procedure, especially fluoroscopic visualization and navigation of the osteoporotic sacrum is technically feasible. A total radiograph time of 7,4 minutes, including image acquisition for navigation and fluoroscopic control of cement injection, is acceptable and can be expected to be significantly reduced with repeated applications of the procedure. The patient presented in the report was discharged to rehabilitation soon after the operation. An assistive device (delta wheel) is only needed for longer walking distances. Pain was reduced drastically immediately after surgery. In general, fractures are treated by reduction and fixation to restore the biomechanical function of the injured bone. These principles should be applied to elderly patients with osteoporotic fractures as well. The technique reported here is adapted to the special demands of the elderly patient, i.e., minimally invasive, support of the weakened bone by cement augmentation, bone protective screw positioning and safety due to navigation support.

Folgen der okkulten Insuffizienzfraktur des Os sacrum

Low back pain disorders of the elderly can potentially be caused by sacral insufficiency fractures due to osteoporosis, radiation necrosis or seldom malignant processes. In our institution an increasing numbers of patients suffering from osteoporotic sacral insufficiency fractures could recently be observed. In a case report study clinical symptoms, diagnostic procedures as well as therapeutic options are discussed.

Percutaneous Sacroplasty for Osteoporotic Insufficiency Fractures

Percutaneous Sacroplasty for Osteoporotic Insufficiency FracturesShigeru EharaAudio Available | Share

Osteoporotic stress fractures of the sacrum: MR-tomography findings

Evaluation of the morphologic appearance of sacral osteoporotic insufficiency fractures in MRI. 6 patients (5 female and one male, 54-80 years) with osteoporotic insufficiency fractures of the sacrum were examined with CT and MRI. Plain and contrast-enhanced T1- and T2-weighted spin-echo images were acquired, three patients were studied with T1-weighted gradient-echo-sequences with fat suppression. Fracture-lines and sclerotic areas of the massae laterales were visible in 5 of 6 CT examinations, one patient showed no abnormalities of the sacrum on the initially performed CT scans. All patients had a diffuse bone marrow oedema of the fractured massae laterales with a decreased signal on the T1-weighted spin-echo images and an increased signal on the T1-weighted gradient-echo images with fat suppression and in the T2-weighted SE-sequences. Gadopentate dimeglumine enhanced MRI images showed a remarkable diffuse configurated high signal of the whole sacrum in bilateral fractures (H-pattern). An additional soft tissue mass could be excluded in each case. Gadopentate dimeglumine enhanced MRI of sacral insufficiency fractures allows early diagnosis and helps to exclude intraosseous tumour formation.