ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
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.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFragility 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
methodsThis 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.
resultsA 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.
conclusionHU-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.
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