When a patient with blunt trauma is admitted to an emergency department, a CT scan is usually ordered. However, if emergency physicians suspect that a patient has a fractured pelvis or acetabulum, and it is not identified by CT, a pelvic x-ray exam should be ordered. Clinical staff at the James Cook University Hospital’s Department of Trauma and Orthopaedics in Middlesbrough, United Kingdom made this recommendation in an article published in the November issue of the Journal of Emergency Medicine.
Fractures of the pelvis and acetabulum occur in approximately 20% of all polytrauma cases, and have a high associated morbidity and mortality, given the risk of significant retroperitoneal bleeding and close association with intraperitoneal organs. Motor vehicle accidents are believed to account for one fifth up to two thirds of all pelvic injuries. Due to the high risk of hemorrhage, application of an external compression splint at the scene of an accident is recommended if emergency responders suspect an injured individual may have a pelvic fracture.
Lead author Jenny Clements and colleagues reported two cases of patients who presented at their Level I trauma center with a suspected pelvic injury wearing a properly applied pelvic compression belt. One patient had a pelvic CT scan and the other a pelvic CT scan and a pelvic radiograph both while wearing the compression belt. None of the examinations identified the significant unstable pelvic injury each patient had sustained.
After x-ray exams were performed after the compression belts had been removed, a type II anterior posterior compression fracture was diagnosed in one patient, and marked pubic symphysis and left-sided sacroiliac joint diastasis in keeping with an anterior posterior compression fracture type III was diagnosed in the other patient.
While acknowledging published studies that suggest plain pelvic x-ray exams can be safely omitted, the authors said that these two cases show that “external compression belts can completely mask significant pelvic injuries due to accurate reduction of the disrupted pelvic ring in purely ligamentous injuries.” Because timely recognition and treatment is essential, when there is high clinical suspicion for pelvic injury, they encourage emergency physicians to order plain pelvic radiographs with pelvic compression belts removed.
X-rays may show pelvic fractures better than CT. Appl Radiol.