Pelvic insufficiency fracture

Pelvic insufficiency fractures are a relatively common subtype of insufficiency fracture, and are recognised as a major cause of low back, buttock and groin pain in susceptible populations.

Patients most frequently present with a history of minor trauma or an insidious onset of pain in the above noted locations.

Senile/postmenopausal osteoporosis is the most common predisposing factor. Other important risk factors include:

Plain film, MRI and scintigraphic appearance at the site of fracture are the same as with all insufficiency fractures. They often occur in characteristic locations and patterns within the pelvis, and are best detected and evaluated using bone scintigraphy and/or MRI. CT is a relatively insensitive method of detection. Pelvic insufficiency fractures are typically occult on plain film unless secondary remodelling has begun.

Common locations include:

  • sacrum: (sacral insufficiency fracture) usually vertically through the sacral ala, paralleling the sacroiliac joint, often with a transverse component - this pattern resembles the capital letter H, leading to the designation H sign (or Honda sign)
  • medial iliac: vertical fracture paralleling the sacroiliac joint
  • supracetabular region: about 1/3 are associated with sacral insufficiency fractures
  • iliac wing: oblique fracture through the iliac wing, oriented somewhat parallel to the iliac crest
  • pubic rami: nearly 90% of fractures at this site occur in conjunction with insufficiency fractures elsewhere within the pelvis
  • parasymphyseal: (parasymphyseal insufficiency fracture 4,5) also frequently associated with other pelvic insufficiency fractures
Share article

Article Information

rID: 21219
Section: Pathology
Synonyms or Alternate Spellings:
  • Pelvic insufficiency fractures

Support Radiopaedia and see fewer ads

Cases and Figures

  • Drag
    The labeled areas...
    Figure 1: diagram - pelvic insufficiency fractures
    Drag here to reorder.
  • Drag
    Case 1
    Drag here to reorder.
  • Drag
    Case 2
    Drag here to reorder.
  • Drag
    Case 3
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.