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E1142. Sacral Bone Fractures: Demystifying the ‘’Sacred Bone’’ Cracks
Authors
  1. Loai Aker; Hamad Medical Corporation
  2. Laith Abandeh; University of Washington, Department of Radiology
  3. Mazin Abdulaziz Foodoul; Hamad Medical Corporation
  4. Mohammed Sabawi; Hamad Medical Corporation
  5. Alaa Al-Taie; Hamad Medical Corporation
Background
Sacral fractures can occur due to traumatic and non-traumatic causes. The importance of appreciating sacral fractures stems from the role of the sacrum in providing stability to the pelvis and spine, and the potential neurologic injury after traumatic sacral fractures. The identification of sacral fractures allows early fracture fixation and stabilization when indicated, which will decrease the risk of surgical complications and pain. Due to the potential risks, and continuously evolving surgical treatments, radiologists should be oriented about sacral fracture patterns, and potential associated injuries. In this educational exhibit, the following topics will be reviewed: Dennis classification system will be defined and illustrated, with demonstration of fracture zones through radiographic and CT scan case-based presentations in exam format with reporting pearls. Isler classification system will be defined and illustrated, with demonstration of multiple fracture types showing fracture zones with radiographic and CT scan case-based presentations in exam format and reporting pearls. AO classification system is briefly defined and illustrated with emphasis on spinopelvic injury (type C). Common associated findings will also be shown (e.g. fracture-dislocation injuries). Sacral insufficiency fracture is demonstrated on different imaging modalities.

Educational Goals / Teaching Points
This exhibit aims to: To briefly review the radiologic anatomy of the sacral bone, and the imaging modalities utilized for identifying sacral fractures. To identify the clinical importance and challenges of diagnosing sacral fractures, and review the associated injuries and complications. To review the relevant classification systems for sacral fractures, including Dennis and Isler and AO classifications. To illustrate various patterns and types of traumatic and insufficiency sacral fractures in a case-based format using multiple modalities. To address the information that needs to be delivered, from the perspective of the trauma and orthopedic surgeon. To describe a common lexicon between radiologist and orthopedist for better communication of radiologic evaluation results regarding sacral injuries.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Sacrum and pelvis. The mechanisms of sacral fractures in different settings, including traumatic and non-traumatic sacral fractures. Imaging techniques - x-ray, computed tomography scans to demonstrate various sacral fractures and different fracture classification systems examples, including Dennis Classification system, Isler classification system and AO classification system. Magnetic Resonance Imaging images will be demonstrated to simplify the findings of sacral insufficiency fractures, and sacral stress fractures.

Conclusion
Sacral fractures are likely to occur in different settings. Due to the vital role of the sacrum in providing stability to the pelvis and spine, and the potential neurologic injury after traumatic sacral fracture, radiologists should be aware of the various sacral fractures patterns, and potential associated injuries.