Pelvis: sacral insufficiency fracture: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Pelvis: sacral insufficiency fracture

Sample item

A 78-year-old osteoporotic woman has severe buttock and low back pain after minimal activity, with a normal pelvic radiograph. A bone scan shows an H-shaped pattern of uptake in the sacrum. What is this sign called?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Honda sign of sacral insufficiency fracture

Sacral insufficiency fractures occur in osteoporotic or irradiated bone with minimal trauma and are often missed on plain films. A bone scan shows an H-shaped or butterfly pattern called the Honda sign, produced by bilateral vertical fractures joined by a transverse one. MRI is the most sensitive investigation, and treatment is analgesia and mobilisation.

Option by option

  • A. Hawkins sign of talar neck fracture

    The Hawkins sign is a lucent subchondral band in the talus.

  • B. Scottie dog collar of spondylolysis

    The Scottie dog collar is seen on oblique lumbar films in spondylolysis.

  • C. Terry Thomas sign of scapholunate dissociation

    The Terry Thomas sign is a widened scapholunate gap on a clenched fist wrist view.

  • D. Honda sign of sacral insufficiency fracture (correct)

    Correct. An H-shaped sacral uptake is the Honda sign.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Honda sign of sacral insufficiency fracture. Sacral insufficiency fractures occur in osteoporotic or irradiated bone with minimal trauma and are often missed on plain films.

Why is "Hawkins sign of talar neck fracture" not the answer?

The Hawkins sign is a lucent subchondral band in the talus.

Why is "Scottie dog collar of spondylolysis" not the answer?

The Scottie dog collar is seen on oblique lumbar films in spondylolysis.

Why is "Terry Thomas sign of scapholunate dissociation" not the answer?

The Terry Thomas sign is a widened scapholunate gap on a clenched fist wrist view.

What concept does this question test?

It tests Pelvis: sacral insufficiency fracture in Orthopaedics. A bone scan shows an H-shaped or butterfly pattern called the Honda sign, produced by bilateral vertical fractures joined by a transverse one. MRI is the most sensitive investigation, and treatment is analgesia and mobilisation.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Pelvis: sacral insufficiency fracture?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.