Imaging of Sacral Stress and Insufficiency Fractures

Ulrich Josef Albert Spiegl; Klaus John Schnake; Georg Osterhoff; Max J. Scheyerer; Bernhard Ullrich; Philipp Bula; Holger Siekmann

doi:10.1055/a-0640-8933

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2019; 157(02): 144-153
DOI: 10.1055/a-0640-8933

Review/Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Radiologische Diagnostik von Stress- und Insuffizienzfrakturen des Sakrums

Article in several languages: English | deutsch

Ulrich Josef Albert Spiegl

¹Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinik Leipzig

,

Klaus John Schnake

²Zentrum für Wirbelsäulentherapie, Schön Kliniken, Fürth

,

Georg Osterhoff

³Klinik für Traumatologie, Universitätsspital Zürich, Zürich, Schweiz

,

Max J. Scheyerer

⁴Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinik Köln

,

Bernhard Ullrich

⁵Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle

,

Philipp Bula

⁶Klinik für Unfall- und Wiederherstellungschirurgie, Orthopädie, Plastische-, Hand- und Mikrochirurgie, Städtisches Klinikum Gütersloh gGmbH, Gütersloh

,

Holger Siekmann

⁷Unfallchirurgie, Universität Halle

› Author Affiliations

Abstract

Zusammenfassung

Sakrumfrakturen, die ohne adäquates Trauma entstanden sind, werden in Insuffizienzfrakturen und Stressfrakturen eingeteilt. Während Insuffizienzfrakturen bei physiologischer Belastung meist auf dem Boden einer relevanten Osteoporose entstehen, beruhen Stressfrakturen auf einer mechanischen Überlastung. Der vordere Beckenring ist regelmäßig beteiligt. Aufgrund des fehlenden bzw. niederenergetischen Unfallhergangs wird die korrekte Diagnose oft verspätet gestellt. Demzufolge war es das Ziel der AG Osteoporotische Frakturen der Sektion Wirbelsäule der DGOU, die einzelnen bildgebenden Verfahren zur korrekten, schnellen und kosteneffektiven Diagnostik vorzustellen. Zur Diagnosesicherung sollte neben der konventionell radiologischen Diagnostik zeitnah eine Schnittbildgebung in die Wege geleitet werden. Mittels CT kann die Frakturmorphologie am besten beurteilt werden, wodurch potenzielle Instabilitätszeichen der Verletzung erkannt werden können. Die MRT kann aufgrund der hohen Sensitivität bei fehlendem Frakturnachweis im CT, bei jungen Patienten und unklaren Situationen zusätzliche wichtige Informationen liefern. Im Falle einer Kontraindikation für das MRT stellen nuklearmedizinische Untersuchungen eine gute Alternative dar.

Schlüsselwörter

Insuffizienzfraktur - Sakrum - Stressfraktur - MRT - CT

Full Text

References

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