Radiological Diagnostics

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Pelvic Ring Fractures
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Abstract

Adequate radiological analysis of the pelvic ring injury leads to an instability-based treatment concept. The detailed analysis of different regions of the pelvic ring allows for the identification of relevant injuries including bony injuries and pelvic joint involvement. The summary of these analyses results in a basic understanding of the injury mechanism and stability assessment. The basic understanding of CT evaluation is important for the identification of vascular lesions and detailed fracture diagnostics.

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References

  1. Advanced trauma life support (ATLS), 9th Edition 2012.

    Google Scholar 

  2. Tscherne H, Pohlemann T. Tscherne unfallchirurgie: becken und acetabulum. Berlin, Heidelberg, New York: Springer-Verlag; 1998.

    Book  Google Scholar 

  3. Tscherne H, Regel G. Tscherne unfallchirurgie: trauma-management. Berlin, Heidelberg, New York: Springer-Verlag; 1997. p. 257–97.

    Book  Google Scholar 

  4. Gercek E, Hessmann M, Rommen P. Bildgebende Diagnostik bei Beckenverletzungen. Akt Traumatol. 2002;32:163–70.

    Article  Google Scholar 

  5. Resnik C, Stackhouse D, Shanmuganathan K, Young J. Diagnosis of pelvic fractures in patients with acute pelvic trauma: efficiency of plain radiographs. AJR. 1992;158:109–12.

    Article  CAS  PubMed  Google Scholar 

  6. Verbeek D, Burgess A. Importance of pelvic radiography for initial trauma assessment: an orthopedic perspective. J Emerg Med. 2016;50:852–8.

    Article  PubMed  Google Scholar 

  7. Edeiken-Monroe B, Browner BD, Jackson H. The role of standard roentgenograms in the evaluation of instability of pelvic ring disruption. Clin Orthop. 1989;240:63–76.

    Google Scholar 

  8. Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160(2):445–51.

    Article  CAS  PubMed  Google Scholar 

  9. Duane TM, Tan BB, Golay D, Cole FJ Jr, Weireter LJ Jr, Britt LD. Blunt trauma and the role of routine pelvic radiographs: a prospective analysis. J Trauma. 2002;53(3):463–8.

    Article  PubMed  Google Scholar 

  10. Borrelli J Jr, Goldfarb C, Catalano L, Evanoff BA. Assessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs. J Orthop Trauma. 2002;16(7):449–56. discussion 456–7

    Article  PubMed  Google Scholar 

  11. Kreitner KF, Mildenberger P, Rommens PM, Thelen M. Rational diagnostic imaging of pelvic and acetabulum injuries. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2000;172(1):5–11.

    Article  CAS  PubMed  Google Scholar 

  12. Pehle B, Nast-Kolb D, Oberbeck R, Waydhas C, Ruchholtz S. Wertigkeit der körperlichen und radiologischen Basisdiagnostik des Beckens in der Schockraumbehandlung. Unfallchirurg. 2003;106:642–8.

    Article  CAS  PubMed  Google Scholar 

  13. Guillamondegui OD, Pryor JP, Gracias VH, Gupta R, Reilly PM, Schwab CW. Pelvic radiography in blunt trauma resuscitation: a diminishing role. J Trauma. 2002;53(6):1043–7.

    Article  PubMed  Google Scholar 

  14. Hilty M, Behrendt I, Benneker L, Martinolli L, Stoupis C, Buggy D, Zimmermann H, Exadaktylos A. Pelvic radiography in ATLS algorithms: a diminishing role? World J Emerg Surg. 2008;3:11. https://doi.org/10.1186/1749-7922-3-11.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Schicho A, Schmidt S, Seeber K, Olivier A, Richter P, Gebhard F. Pelvic X-ray misses out on detecting sacral fractures in the elderly - importance of CT imaging in blunt pelvic trauma. Injury. 2016;47:707–10.

    Article  PubMed  Google Scholar 

  16. Soto J, Zhou C, Hu D, Arazoza A, Dunn E, Sladek P. Skip and save: utility of pelvic x-rays in the initial evaluation of blunt trauma patients. Am J Surg. 2015;210:1076–9.

    Article  PubMed  Google Scholar 

  17. Their M, Bensch F, Koskinen S, Handolin L, Kiuru M. Diagnostic value of pelvic radiography in the initial trauma series in blunt trauma. Eur Radiol. 2005;15:1533–7.

    Article  PubMed  Google Scholar 

  18. Traumaregister, Jahresbericht, www.traumaregister.de. 2018.

  19. OTA. Fracture and dislocation compendium. J Orthop Trauma. 1996;10(Suppl. 1):71–5.

    Google Scholar 

  20. Letournel E. Annotation to pelvic fractures. Injury. 1978;10:145–8.

    Article  CAS  PubMed  Google Scholar 

  21. Denis F, Steven D, Comfort T. Sacral fractures: an important problem, retrospective analysis of 236 cases. Clin Orthop. 1988;227:67–81.

    CAS  PubMed  Google Scholar 

  22. Björklund K, Bergström S, Lindgren P, Ulmsten U. Ultrasonographic measurement of the symphysis pubis: a potential method of studying symphyseolysis in pregnancy. Gynecol Obstet Investig. 1996;42:151–3.

    Article  Google Scholar 

  23. Gamble JG, Simmons SC, Freedman M. The symphysis pubis. Anatomic and pathologic considerations. Clin Orthop Relat Res. 1986;203:261–72.

    Google Scholar 

  24. Loeschcke H. Untersuchungen über die Entstehung und Bedeutung der Spaltbildungen in der Symphyse, sowie über physiologische Erweiterungsvorgaenge am Becken Schwangerer und Gebärender. Archiv Gynaek. 1912;96:525–60.

    Google Scholar 

  25. Vix V, Ryu C. The adult symphysis pubis: normal and abnormal. Am J Roentgenol Radium Therapy, Nucl Med. 1971;112:517–25.

    Article  CAS  Google Scholar 

  26. Krauss F. Über Symphysensprengung. Zentbl Chir. 1930;3:134–5.

    Google Scholar 

  27. Patel K, Chapman S. Normal symphysis width in children. Clin Radiol. 1993;47:56–7.

    Article  CAS  PubMed  Google Scholar 

  28. Alicioglu B, Kartal O, Gurbuz H, Sut N. Symphysis pubis distance in adults: a retrospective computed tomography study. Surg Radiol Anat. 2008;30:153–7.

    Article  PubMed  Google Scholar 

  29. McAlister D, Webb H, Wheeler P, Shinault K, Teague D, Fish J, Beall D. Pubic symphyseal width in pediatric patients. J Pediatr Orthop. 2005;25:725–7.

    Article  PubMed  Google Scholar 

  30. Bayer J, Neubauer J, Saueressig U, Südkamp N, Reising K. Age- and gender-related characteristics of the pubic symphysis and triradiate cartilage in pediatric computed tomography. Pediatr Radiol. 2016;46:1705–12.

    Article  PubMed  Google Scholar 

  31. Kalenderer Ö, Turgut A, Bacaksız T, Bilgin E, Kumbaracı M, Akkan H. Evaluation of symphysis pubis and sacroiliac joint distances in skeletally immature patients: a computerized tomography study of 1020 individuals. Acta Orthop Traumatol Turc. 2017;51:150–4.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Oetgen M, Andelman S, Martin B. Age-based normative measurements of the pediatric pelvis. J Orthop Trauma. 2017;31:e205–9.

    Article  PubMed  Google Scholar 

  33. Garras D, Carothers J, Olson S. Single-leg-stance (flamingo) radiographs to assess pelvic instability: how much motion is normal? J Bone Joint Surg Am. 2008;90:2114–8.

    Article  PubMed  Google Scholar 

  34. Siegel J, Templeman D, Tornetta PR. Single-leg-stance radiographs in the diagnosis of pelvic instability. J Bone Joint Surg Am. 2008;90:2119–25.

    Article  PubMed  Google Scholar 

  35. Rustamova S, Predanic M, Sumersille M, Cohen W. Changes in symphysis pubis width during labor. J Perinat Med. 2009;37:370–3.

    Article  PubMed  Google Scholar 

  36. Hefzy MS, Ebraheim N, Mekhail A, Caruntu D, Lin H, Yeasting R. Kinematics of the human pelvis following open book injury. Med Eng Phys. 2003;25(4):259–74.

    Article  CAS  PubMed  Google Scholar 

  37. Gary J, Mulligan M, Banagan K, Sciadini M, Nascone J, O’Toole R. Magnetic resonance imaging for the evaluation of ligamentous injury in the pelvis: a prospective case-controlled study. J Orthop Trauma. 2014;28:41–7.

    Article  PubMed  Google Scholar 

  38. Northrop C, Eto R, Loop J. Vertical fracture of the sacral ala: significance of non-continuity of the anterior superior sacral foraminal line. AJR. 1975;124:102–6.

    Article  CAS  Google Scholar 

  39. Roy-Camille R, Saillant G, Gagana G, Mazel C. Transverse fracture of the upper sacrum: suicidal jumper’s fracture. Spine. 1985;10(9):838–45.

    Article  CAS  PubMed  Google Scholar 

  40. Maqungo S, Kimani M, Chhiba D, McCollum G, Roche S. The L5 transverse process fracture revisited. Does its presence predict the pelvis fracture instability? Injury. 2015;46:1629–30.

    Article  PubMed  Google Scholar 

  41. Nasef H, Elhessy A, Abushaban F, Alhammoud A. Pelvic fracture instability-associated L5 transverse process fracture, fact or myth? A systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2018;28:885–91.

    Article  PubMed  Google Scholar 

  42. Starks I, Frost A, Wall P, Lim J. Is a fracture of the transverse process of L5 a predictor of pelvic fracture instability? J Bone Joint Surg (Br). 2011;93:967–9.

    Article  CAS  Google Scholar 

  43. Winkelmann M, Lopez Izquierdo M, Clausen J, Liodakis E, Mommsen P, Blossey R, Krettek C, Zeckey C. Fractures of the transverse processes of the fourth and fifth lumbar vertebrae in patients with pelvic ring injuries: indicator of biomechanical instability but not shock.´. Bone Joint J. 2018;100:1214–9.

    Article  PubMed  Google Scholar 

  44. Sagi H, Coniglione F, Stanford J. Examination under anesthetic for occult pelvic ring instability. J Orthop Trauma. 2011;25:529–36.

    Article  PubMed  Google Scholar 

  45. Pennal G, Tile M, Waddell J, Garside H. Pelvic disruption: assessment and classification. Clin Orthop. 1980;151:12–21.

    Google Scholar 

  46. Pekmezci M, Rotter P, Toogood P, Morshed S, Kandemir U. Reexamination of pelvic inlet and outlet images using 3-dimensional computed tomography reconstructions. J Orthop Trauma. 2014;28:324–9.

    Article  PubMed  Google Scholar 

  47. Ricci W, Mamczak C, Tynan M, Streubel P, Gardner M. Pelvic inlet and outlet radiographs redefined. J Bone Joint Surg. 2010;92-A:1947–53.

    Article  Google Scholar 

  48. Ziran B, Wasan A, Marks D, Olson S, Chapman M. Fluoroscopic imaging guides of the posterior pelvis pertaining to iliosacral screw placement. J Trauma. 2007;62:347–56.

    Article  PubMed  Google Scholar 

  49. Pohlemann T, Gänsslen A, Hartung S, Arbeitsgruppe Becken HT, Tscherne H. Beckenverletzungen/Pelvic Injuries. Hefte zu “Der Unfallchirurg”. Berlin: Springer; 1998. p. 266.

    Google Scholar 

  50. Young P, Ho K, Nair S, Yeon W. Optimal pelvic inlet and outlet radiograph angles in Korean patients. J Korean Orthop Assoc. 2012;47:9–14.

    Article  Google Scholar 

  51. Lefaivre K, Blachut P, Starr A, Slobogean G, O’Brien P. Radiographic displacement in pelvic ring disruption: reliability of 3 previously described measurement techniques. J Orthop Trauma. 2014;28:160–6.

    Article  PubMed  Google Scholar 

  52. Nystrom L, McKinley T, Marsh J. Radiographic measurement of rotational deformity in pelvic fractures: a novel method with validity and reliability testing. J Orthop Trauma. 2015;29:365–9.

    Article  PubMed  Google Scholar 

  53. Boontanapibul K, Harnroongroj T, Sudjai N, Harnroongroj T. Vertical pelvic ring displacement in pelvic ring injury: measurements in pelvic outlet radiograph and in cadavers. Ind J Orthop. 2015;49:425–8.

    Article  Google Scholar 

  54. Elnahal W, Vetharajan N, Mohamed B, Acharya M, Chesser T, Ward A. Routine postoperative computed tomography scans after pelvic fracture fixation: a necessity or a luxury? J Orthop Trauma. 2018;32:S66–71.

    Article  PubMed  Google Scholar 

  55. Anderson S, Soto J, Lucey B, Burke P, Hirsch E, Rhea J. Blunt trauma: feasibility and clinical utility of pelvic CT angiography performed with 64-detector row CT. Radiology. 2008;246:410–9.

    Article  PubMed  Google Scholar 

  56. Hamilton J, Kumaravel M, Censullo M, Cohen A, Kievlan D, West O. Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics. 2008;28:1603–16.

    Article  PubMed  Google Scholar 

  57. Mohseni S, Talving P, Kobayashi L, Lam L, Inaba K, Branco B, Oliver M, Demetriades D. The diagnostic accuracy of 64-slice computed tomography in detecting clinically significant arterial bleeding after pelvic fractures. Am Surg. 2011;77:1176–82.

    Article  PubMed  Google Scholar 

  58. Hallinan J, Tan C, Pua U. Emergency computed tomography for acute pelvic trauma: where is the bleeder? Clin Radiol. 2014;69:529–37.

    Article  CAS  PubMed  Google Scholar 

  59. Shenton A, Choudhary S. The emergency radiology of pelvicbtrauma. Trauma. 2014;16:279–91.

    Article  Google Scholar 

  60. Tanizaki S, Maeda S, Ishida H, Yamamoto T, Yoshikawa J. Clinical characteristics of external iliac artery branch injury in pelvic trauma. Am J Emerg Med. 2017;35:1636–8.

    Article  PubMed  Google Scholar 

  61. Vasanawala S, Desser T. Value of delayed imaging in MDCT of the abdomen and pelvis. AJR. 2006;187:154–63.

    Article  PubMed  Google Scholar 

  62. Anderson S, Lucey B, Rhea J, Soto J. 64 MDCT in multiple trauma patients: imaging manifestations and clinical implications of active extravasation. Emerg Radiol. 2007;14:151–9.

    Article  PubMed  Google Scholar 

  63. Maturen K, Adusumilli S, Blane C, Arbabi S, Williams D, Fitzgerald J, Vine A. Contrast-enhanced CT accurately detects hemorrhage in torso trauma: direct comparison with angiography. J Trauma. 2007;62:740–5.

    Article  PubMed  Google Scholar 

  64. Yoon W, Kim J, Jeong Y, Seo J, Park J, Kang H. Pelvic arterial hemorrhage in patients with pelvic fractures: detection with contrast-enhanced CT. Radiographics. 2004;24:1591–605.

    Article  PubMed  Google Scholar 

  65. Uludag N, Tötterman A, Beckman M, Sundin A. Anatomic distribution of hematoma following pelvic fracture. Br J Radiol. 2018;91(1085):20170840. https://doi.org/10.1259/bjr.20170840.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Dreizin D, Bodanapally U, Boscak A, Tirada N, Issa G, Nascone J, Bivona L, Mascarenhas D, O’Toole R, Nixon E, Chen R, Siegel E. CT prediction model for major arterial injury after blunt pelvic ring disruption. Radiology. 2018;287:1061–9.

    Article  PubMed  Google Scholar 

  67. Rommens P, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury. 2013;44:1733–44.

    Article  PubMed  Google Scholar 

  68. Potter H, Montgomery K, Padgett D, Salvati E, Helfet D. Magnetic resonance imaging of the pelvis. Clin Orthop. 1995;319:223–31.

    Google Scholar 

  69. Rubel IF, Potter H, Barie P, Kloen P, Helfet DL. Magnetic resonance venography to evaluate deep venous thrombosis in patients with pelvic and acetabular trauma. J Trauma. 2001;51(3):622.

    CAS  PubMed  Google Scholar 

  70. Potter H, Montgomery K, Heise C, Helfet D. MR imaging of acetabular fractures: value in detecting femoral head injury, intraarticular fragments and sciatic nerve injury. AJR. 1994;163:881–6.

    Article  CAS  PubMed  Google Scholar 

  71. Nüchtern J, Hartel M, Henes F, Groth M, Jauch S, Haegele J, Briem D, Hoffmann M, Lehmann W, Rueger J, Großterlinden L. Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures. Injury. 2015;46:315–9.

    Article  PubMed  Google Scholar 

  72. Geerts W, Coren K, Jay R, Chen E, Szalai J. A prospective study of venous thromboembolism after major trauma. New Engl J Med. 1994;331(24):1601–6.

    Article  CAS  PubMed  Google Scholar 

  73. Davies R, Scrimshire A, Sweetman L, Anderton M, Holt E. A decision tool for whole-body CT in major trauma that safely reduces unnecessary scanning and associated radiation risks: an initial exploratory analysis. Injury. 2016;47:43–9.

    Article  PubMed  Google Scholar 

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Grechenig, P., Grechenig, S., Bakota, B., Gänsslen, A. (2021). Radiological Diagnostics. In: Gänsslen, A., Lindahl, J., Grechenig, S., Füchtmeier, B. (eds) Pelvic Ring Fractures. Springer, Cham. https://doi.org/10.1007/978-3-030-54730-1_7

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