The informative value of computed tomography compared to plain radiography in diagnosing traumatic sacral fractures

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Abstract

The sacrum evenly distributes the mechanical loading between the pelvis and the lower limbs. Sacral fractures make up a heterogeneous group of fractures, which, moreover, rarely occur as isolated fractures. They are usually associated with fractures of the pelvis and pelvic ring. Due to the low incidence, heterogeneity, and in some cases the isolated nature of the lesion, this group of fractures often remains undiagnosed early enough. Diagnostic mistakes could lead to serious consequences for the patient's health in the future, primarily neurological complications.

Nowadays there is a tendency of an increasing frequency of correctly and early diagnosed isolated traumatic sacral fractures, which happens because of the spread of using computed tomography (CT) as the method of choice for diagnosing this pathology. CT is the most preferred method for the primary differential diagnosis of traumatic sacral fractures. This method is of high sensitivity and specificity, much ahead of a plain X-ray, and is as well accessible and simple.

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About the authors

V. P. Kutsenko

Saint Petersburg State Pediatric Medical University of the Russian Health Ministry

Author for correspondence.
Email: val9126@mail.ru

Candidate of Medical Sciences

Russian Federation

A. A. Libert

Saint Petersburg State Pediatric Medical University of the Russian Health Ministry

Email: val9126@mail.ru
Russian Federation

S. V. Menshikova

Saint Petersburg State Pediatric Medical University of the Russian Health Ministry

Email: val9126@mail.ru

Associate Professor

Russian Federation

P. V. Seliverstov

S.M. Kirov Military Medical Academy, Ministry of Defense of Russia

Email: val9126@mail.ru

Candidate of Medical Sciences

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Pelvis X-ray of patient D., anterior-posterior (a) and lateral left (б) view, in supine position, dated 01.02.2022. Description of the radiologist: no bone deformities; no fracture lines detected; slight medial displacement of the distal coccygeal vertebra in relation to the inferior vertebra; signs of a slight subluxation of the distal vertebra of the coccyx without any bone deformity; to exclude bone compression of the coccygeal vertebrae and according to clinical indications, a CT of the coccyx is recommended (the area of interest – coccygeal vertebrae). Conclusion: subluxation of the distal vertebra of the coccyx

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3. Fig. 2. CT of the S4 in axial projection, a layered series (а–г), and in sagittal projection (д), dated 06.02.2022. Arrows show the fracture lines. Description of the radiologist: comminuted fracture of the left half of S4, with slight displacement of the fragment; there is a displacement of the body of Co2 anteriorly in relation to the overlying by 2 mm (post-traumatic antelisthesis). Consultation with a traumatologist is recommended. Conclusion: closed fracture of S4 with slight displacement of fragments; displacement of the body of Co2 anteriorly in relation to the overlying by 2 mm

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4. Fig. 3. CT of the S4, in axial projection from 06.02.2022: a – comminuted fracture of the left half of the sacrum at the S4 level without displacement of the fragment; b – fused fracture of the wing of the left iliac bone; c – bone tissue zone with reduced densitometric indicators (about 890 HU units)

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5. Fig. 4. Control CT of S4 of patient D., in axial projection, a layered series (а–г), and in sagittal projection (д), in supine position, dated 29.03.2022. The arrows show the continuity of the bone cortical

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