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Pelvic Fractures Workup

  • Author: George V Russell Jr, MD; Chief Editor: William L Jaffe, MD  more...
 
Updated: Jan 25, 2016
 

Laboratory Studies

A complete blood count (CBC), renal panel, coagulation profile, and toxicology screens usually are obtained in the emergency department upon patient presentation. Serial hematocrits are helpful in the acute setting to monitor resuscitation efforts.

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Imaging Studies

Radiography

An anteroposterior (AP) pelvic radiograph (see the images below) is obtained as a component of the initial trauma evaluation. It highlights most major pelvic disruptions[33]

Anteroposterior compression pelvic fracture. Anteroposterior compression pelvic fracture.
Anteroposterior compression pelvic fracture with a Anteroposterior compression pelvic fracture with associated Denis zone II sacral fracture. Symphysis was plated with 3.5-mm reconstruction plate, and sacrum was fixed with iliosacral screws.

An inlet pelvic radiograph[31]  is obtained with the x-ray tube angled 45° caudad and centered on the umbilicus. It highlights AP and mediolateral translations, as well as internal and external rotatory deformities.

An outlet pelvic radiograph[31]  is obtained with the x-ray tube angled 45° cephalad and centered on the symphysis pubis. It highlights superior and inferior translations, abduction and/or adduction, and flexion and/or extension rotational deformities

A lateral sacral radiograph[34, 35]  is indicated in injuries sustained from falls and when bilateral sacral fractures are noted on plain radiography or computed tomography (CT). It demonstrates transverse fracture of the sacral body and/or kyphosis of the sacrum.

Computed tomography

Pelvic CT scans[36, 37] (see the image below) are useful for confirming plain film findings and for documenting sacral morphology when percutaneous iliosacral screw placement[38]  is planned. They often can be included with abdominal CT scans. First, 5-mm axial images are obtained from iliac crests to acetabular dome; then, 3-mm axial images, including all acetabular articular segments; and finally, 5-mm slices through the remainder of the caudal pelvis[30]  Three-dimensional reformatted pelvic CT scans also may help highlight pelvic ring injuries and associated deformity patterns.

Crescent fracture on CT scan. Crescent fracture on CT scan.

Hilty et al performed a retrospective analysis of 68 polytraumatized patients to determine whether radiographs and CT were both necessary to definitively diagnose pelvic fracture or whether CT alone would be sufficient. They found that in hemodynamically stable patients with a clinically stable pelvis, radiographs had only a 67% sensitivity and could be safely omitted as long as CT is planned and available.[36]

Pelvic angiography

Pelvic angiography is indicated in patients with ongoing hemorrhage after adequate intravenous fluid resuscitation and provisional pelvic ring stabilization. It is useful for detecting obvious or occult injury to the superior gluteal artery in patients who have pelvic ring or acetabular injuries involving the greater sciatic notch. Embolization of lacerated arterial vessels may be performed at the same setting, as can manipulative reductions using the angiography fluoroscopic imaging system.

Retrograde urethrography

Retrograde urethrography is Indicated in patients suspected of having urethral tears. It is recommended that this procedure be performed under the direction of a urologist.

Cystography

Cystography is indicated in patients suspected of having a urinary bladder injury. It is recommended that this procedure be performed under the direction of a urologist.

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Contributor Information and Disclosures
Author

George V Russell Jr, MD Assistant Professor, Department of Orthopedic Surgery and Rehabilitation, University of Mississippi Medical Center

George V Russell Jr, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, National Medical Association, Orthopaedic Trauma Association, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Received none from Zimmer for stockholder; Received grant/research funds from Stryker for research investigator; Received grant/research funds from Synthes for research investigator.

Coauthor(s)

Christopher A Jarrett, MD Fellow in Adult Reconstruction, Department of Orthopedic Surgery, Lenox Hill Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

James J McCarthy, MD, FAAOS, FAAP Director, Division of Orthopedic Surgery, Cincinnati Children's Hospital; Professor, Department of Orthopedic Surgery, University of Cincinnati College of Medicine

James J McCarthy, MD, FAAOS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Orthopaedic Association, Pennsylvania Medical Society, Philadelphia County Medical Society, Pennsylvania Orthopaedic Society, Pediatric Orthopaedic Society of North America, Orthopaedics Overseas, Limb Lengthening and Reconstruction Society, Alpha Omega Alpha, American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Orthopediatrics, Phillips Healthcare, POSNA<br/>Serve(d) as a speaker or a member of a speakers bureau for: Synthes<br/>Received research grant from: University of Cincinnati<br/>Received royalty from Lippincott Williams and WIcins for editing textbook; Received none from POSNA for board membership; Received none from LLRS for board membership; Received consulting fee from Synthes for none.

Chief Editor

William L Jaffe, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Vice Chairman, Department of Orthopedic Surgery, New York University Hospital for Joint Diseases

William L Jaffe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American College of Surgeons, Eastern Orthopaedic Association, New York Academy of Medicine

Disclosure: Received consulting fee from Stryker Orthopaedics for speaking and teaching.

Additional Contributors

B Sonny Bal, MD, JD, MBA Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

B Sonny Bal, MD, JD, MBA is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Received none from Bonesmart.org for online orthopaedic marketing and information portal; Received none from OrthoMind for social networking for orthopaedic surgeons; Received stock options and compensation from Amedica Corporation for manufacturer of orthopaedic implants; Received ownership interest from BalBrenner LLC for employment; Received none from ConforMIS for consulting; Received none from Microport for consulting.

Acknowledgements

ML Chip Routt, Jr, MD Professor, Department of Orthopedics, University of Washington School of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, Harborview Medical Center, University of Washington Medical Center

ML Chip Routt, Jr, MD, is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, and Washington State Medical Association

Disclosure: Nothing to disclose.

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Anteroposterior compression pelvic fracture.
Vertical shear pelvic fracture.
Crescent fracture on CT scan.
Anteroposterior compression pelvic fracture with associated Denis zone II sacral fracture. Symphysis was plated with 3.5-mm reconstruction plate, and sacrum was fixed with iliosacral screws.
 
 
 
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