Pelvic Fractures Workup

Updated: Feb 26, 2018
  • Author: George V Russell Jr, MD; Chief Editor: William L Jaffe, MD  more...
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Workup

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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