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Background <p>Fragility fractures of the pelvis (FFP) show high prevalence in the elderly. Due to low energy trauma diagnostics remain challenging. Magnetic resonance imaging (MRI) provides high sensitivity for bone marrow edema but is costly and occasionally contraindicated, whereas computed tomography (CT) is widely available but may miss occult fractures. By determining a Hounsfield unit (HU)–based cutoff value for unilateral posterior pelvic ring fractures this study might support an early detection of occult posterior pelvic ring fractures.</p> Materials and methods <p>This retrospective single-center study included patients ≥ 65 years with FFP type I–III treated between 2018 and 2023. Demographic data, osteoporotic therapy, vitamin D levels, and imaging modalities were recorded. CT scans were analyzed with regions of interest in the first sacral vertebral body and alae. HU differences between fractured and contralateral sacral alae were calculated. Statistical testing included Mann–Whitney U and logistic regression.</p> Results <p>A total of 284 patients (median age 86 years, 83% female) were analyzed. Most sustained FFP II (70.7%), followed by FFP I (23.5%) and FFP III (5.8%). Osteoporosis was diagnosed in 43.9% at admission, but only 30.6% received basic and 11.9% specific therapy before hospitalization. No significant HU differences were found in the S1 vertebral body across FFP types. Whereas HU difference in sacral alae was significant in FFP II (41.7 ± 29.3 HU) and FFP III (55.3 ± 34.4 HU) compared to FFP I (11.8 ± 6.6 HU). Logistic regression identified a cutoff of 34.1 HU, corresponding to a 95% probability of unilateral fracture detection.</p> Conclusion <p>HU-based CT analysis might provide useful information for diagnosing occult unilateral posterior pelvic ring fractures. Applying HU thresholds may improve early detection and optimize treatment strategies.</p>

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Opportunistic bone density measurement on fragility fracture of the pelvis II and III: Hounsfield units might help to reveal dormant fractures in native computed tomography scan

  • 期刊论文

  • 发表日期：

    2026年1月22日

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  • Andreas Termer,
  • Philipp Krautz,
  • Katharina Hinrichs,
  • Anica Herlyn,
  • Tim Fülling,
  • Philip Gierer

摘要

Background

Fragility fractures of the pelvis (FFP) show high prevalence in the elderly. Due to low energy trauma diagnostics remain challenging. Magnetic resonance imaging (MRI) provides high sensitivity for bone marrow edema but is costly and occasionally contraindicated, whereas computed tomography (CT) is widely available but may miss occult fractures. By determining a Hounsfield unit (HU)–based cutoff value for unilateral posterior pelvic ring fractures this study might support an early detection of occult posterior pelvic ring fractures.

Materials and methods

This retrospective single-center study included patients ≥ 65 years with FFP type I–III treated between 2018 and 2023. Demographic data, osteoporotic therapy, vitamin D levels, and imaging modalities were recorded. CT scans were analyzed with regions of interest in the first sacral vertebral body and alae. HU differences between fractured and contralateral sacral alae were calculated. Statistical testing included Mann–Whitney U and logistic regression.

Results

A total of 284 patients (median age 86 years, 83% female) were analyzed. Most sustained FFP II (70.7%), followed by FFP I (23.5%) and FFP III (5.8%). Osteoporosis was diagnosed in 43.9% at admission, but only 30.6% received basic and 11.9% specific therapy before hospitalization. No significant HU differences were found in the S1 vertebral body across FFP types. Whereas HU difference in sacral alae was significant in FFP II (41.7 ± 29.3 HU) and FFP III (55.3 ± 34.4 HU) compared to FFP I (11.8 ± 6.6 HU). Logistic regression identified a cutoff of 34.1 HU, corresponding to a 95% probability of unilateral fracture detection.

Conclusion

HU-based CT analysis might provide useful information for diagnosing occult unilateral posterior pelvic ring fractures. Applying HU thresholds may improve early detection and optimize treatment strategies.