The trauma pelvic X-ray: Not all pelvic fractures are created equally

Elizabeth R Benjamin; Dominik A Jakob; Lee Myers; Panagiotis Liasidis; Meghan Lewis; Yong Fu; Demetrios Demetriades

doi:10.1016/j.amjsurg.2022.01.009

The trauma pelvic X-ray: Not all pelvic fractures are created equally

Am J Surg. 2022 Jul;224(1 Pt B):489-493. doi: 10.1016/j.amjsurg.2022.01.009. Epub 2022 Jan 31.

Authors

Elizabeth R Benjamin¹, Dominik A Jakob², Lee Myers³, Panagiotis Liasidis⁴, Meghan Lewis⁵, Yong Fu⁶, Demetrios Demetriades⁷

Affiliations

¹ Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County + University of Southern California Medical Center, University of Southern California, Los Angeles, CA, 90033, USA. Electronic address: ebenja2@emory.edu.
² Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County + University of Southern California Medical Center, University of Southern California, Los Angeles, CA, 90033, USA. Electronic address: Dominik.a.jakob@gmail.com.
³ Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County + University of Southern California Medical Center, University of Southern California, Los Angeles, CA, 90033, USA. Electronic address: Leemyers@med.usc.edu.
⁴ Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County + University of Southern California Medical Center, University of Southern California, Los Angeles, CA, 90033, USA. Electronic address: Panliasidis@gmail.com.
⁵ Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County + University of Southern California Medical Center, University of Southern California, Los Angeles, CA, 90033, USA. Electronic address: Meghan.Lewis@med.usc.edu.
⁶ Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County + University of Southern California Medical Center, University of Southern California, Los Angeles, CA, 90033, USA. Electronic address: fuyuxinfuyong@sina.com.
⁷ Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County + University of Southern California Medical Center, University of Southern California, Los Angeles, CA, 90033, USA. Electronic address: Demetrios.Demetriades@med.usc.edu.

PMID: 35131085
DOI: 10.1016/j.amjsurg.2022.01.009

Abstract

Background: The primary aim of this study was to evaluate the role of the initial pelvic X-ray in identifying significant pelvic fractures, which could result in changes in the management of the patient.

Methods: Patients admitted to a level I trauma center (2010-2019) with a severe blunt pelvic fracture (AIS ≥3) were identified. Included in the analysis were patients who underwent emergency department pelvic X-ray followed by CT scan. A control group of patients without pelvic fractures was also included in the study. All investigations were reviewed by a blinded attending trauma radiologist. Pelvic X-ray findings and CT scan reports were compared according to the specific pelvic fracture location, and severity.

Results: Overall, pelvic X-ray was diagnosed 252 of the 285 pelvic fractures (sensitivity 88.4%) and wrongly diagnosed a facture in 3 of 97 patients without a fracture (specificity 96.9%). In 29/184 (15.8%) of patients with pelvic fracture AIS 3, the pelvic X-ray was read as normal, missing the fracture, compared with 4/101 (4.0%) in the AIS 4/5 group (p = 0.003). Pelvic X-ray had the lowest sensitivity in ischial (10.7%), iliac (28.7%), acetabular (42.4%), and sacral fractures (49.1%) and was best for detecting symphysis diastasis (89.8%).

Conclusion: Pelvic X-ray is useful in identifying pubic symphysis diastasis. However, it misses or underestimates a significant number of fractures. CT scan evaluation should be performed in patients with a suspicious mechanism or clinical suspicion of pelvic fracture.

Keywords: Accuracy; CT-scan; Pelvic X-ray; Sensitivity; Specificity.

MeSH terms

Fractures, Bone* / diagnostic imaging
Humans
Pelvic Bones* / diagnostic imaging
Pelvic Bones* / injuries
Radiography
Retrospective Studies
Spinal Fractures* / diagnostic imaging
X-Rays