Pelvic Fractures Workup

  • Author: George V Russell, Jr, MD; Chief Editor: William L Jaffe, MD   more...
 
Updated: Aug 31, 2011
 

Laboratory Studies

  • A complete blood cell count, 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

  • Anteroposterior pelvic radiograph
    • Obtained as component of the initial trauma evaluation
    • Highlights most major pelvic disruptions[33]
  • Inlet pelvic radiograph[27]
    • X-ray tube angled 45° caudad and centered on the umbilicus
    • Highlights AP and mediolateral translations, and internal and external rotatory deformities
  • Outlet pelvic radiograph[27]
    • X-ray tube angled 45° cephalad and centered on the symphysis pubis
    • Highlights superior and inferior translations, abduction and/or adduction, and flexion and/or extension rotational deformities
  • Lateral sacral radiograph[34, 35]
    • Indicated in injuries sustained from falls and when bilateral sacral fractures are noted on plain radiographs or CT scans
    • Demonstrates transverse fracture of sacral body and/or kyphosis of sacrum
  • Pelvic CT scans[14, 36]
    • Useful to confirm plain film findings and more to document sacral morphology when planning percutaneous iliosacral screw placement[37]
    • Often can be included with abdominal CT scans
    • Five-millimeter axial images from iliac crests to acetabular dome, then 3-mm axial images including all acetabular articular segments, then 5-mm slices through remainder of caudal pelvis[26]
    • Three-dimensional reformatted pelvic CT scans also may be beneficial to highlight pelvic ring injuries and associated deformity patterns
  • Pelvic angiograms
    • Indicated in patients with ongoing hemorrhage after adequate intravenous fluid resuscitation and provisional pelvic ring stabilization
    • Useful in patients who have pelvic ring or acetabular injuries involving the greater sciatic notch to detect obvious or occult injury to the superior gluteal artery
    • Embolization of lacerated arterial vessels may be performed at the same setting, as can manipulative reductions using the angiography fluoroscopic imaging system
  • Retrograde urethrogram
    • Indicated in patients suspected of having urethral tears
    • Recommended to be performed under the direction of a urologist
  • Cystogram
    • Indicated in patients suspected of having a urinary bladder injury
    • Recommended to 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, and Southern Orthopaedic Association

Disclosure: Zimmer None Stockholder; Stryker Grant/research funds Research Investigator; Synthes Grant/research funds Research Investigator

Coauthor(s)

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

Disclosure: Nothing to disclose.

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.

Specialty Editor Board

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

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

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

James J McCarthy, MD, FAAOS, FAAP  Associate Professor, Consulting Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health

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

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

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 College of Surgeons, American Orthopaedic Association, Eastern Orthopaedic Association, and New York Academy of Medicine

Disclosure: Stryker Orthopaedics Consulting fee Speaking and teaching

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