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Radiologische Diagnostik von Beckenringfrakturen

Radiological diagnosis of pelvic ring fractures

  • Leitthema
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Zusammenfassung

Epidemiologie

Traumatische Beckenringfrakturen sind vergleichsweise selten, erhöhen jedoch das Mortalitätsrisiko. Nach Verletzungsmechanismus und Hauptvektor der Energieeinwirkung unterscheidet man die anteroposteriore Kompression, die laterale Kompression und die vertikale Scherung (Young-Burgess-Klassifikation), während die stabilitätsbezogene Klassifikation nach Tile zwischen Typ A (stabil), Typ B (rotatorisch instabil) und Typ C (komplett instabil) unterscheidet. Beide Klassifikationen finden Eingang in die AO/OTA-Klassifikation.

Radiologische Frakturdiagnostik

Die Projektionsradiographie besitzt eine schlechte Sensitivität, wird aber noch zur Erkennung hochinstabiler Beckenfrakturen eingesetzt. Die CT stellt die diagnostische Modalität der Wahl dar (Sensitivität bis 100 %). Neben der Frakturklassifikation erlaubt sie auch die sichere Mitbeurteilung assoziierter Gefäß- und Harnblasen‑/Harnröhrenverletzungen sowie großer Weichteileinblutungen. Frühe Insuffizienzfrakturen des Beckens sowie Cauda- und Plexusverletzungen können besser mit der MRT erfasst werden. Angiographie, Sonographie und nuklearmedizinische Methoden stellen zusätzliche wichtige diagnostische und therapeutische Verfahren dar.

Empfehlung für die Praxis

Die Kenntnis grundsätzlicher pelviner Traumamechanismen ist wichtig, um traumatische Beckenfrakturen in ihrer potenziellen Schwere zu erfassen und hinsichtlich ihrer Stabilität richtig zu klassifizieren. Typische Begleitverletzungen bei Beckenringfrakturen müssen bekannt sein, sollten sicher diagnostiziert und dem Kliniker kommuniziert werden. Dabei bleibt die CT das „diagnostische Arbeitspferd“. Bei Fragilitätsfrakturen des Beckens ist auf den oftmals prolongierten Verlauf mit Frakturprogredienz zu achten, weswegen die MRT hier einen besonderen Stellenwert besitzt.

Abstract

Epidemiology

Traumatic fractures of the pelvic ring are relatively rare, but are associated with increased risk of mortality. Depending on injury mechanism and main vector of energy impact, a distinction is made between anteroposterior compression, lateral compression, and vertical shear (Young and Burgess classification), while the stability-related classification according to Tile distinguishes between type A (stable), type B (rotationally unstable) and type C (completely unstable). A comprehensive modern classification is given by the AO/OTA.

Radiological fracture diagnosis

Plain pelvis x‑rays lack sufficient sensitivity but are still used to detect highly unstable pelvic fractures. CT has superior sensitivity and specificity. In addition to fracture classification, CT allows reliable assessment of associated vascular and bladder/urethral injuries and large soft tissue hemorrhage. MRI is unparalleled in showing bone marrow edema, cauda and plexus complications, and peripelvic soft tissue damage. MRI may also prove to be a valuable diagnostic tool for pelvic ring injuries in children, adolescents and young women, provided they are hemodynamically stable. Angiography, ultrasonography and bone scintigraphy are additional important diagnostic and therapeutic options.

Practical recommendations

Knowledge of basic pelvic trauma mechanisms is important to understand the potential severity of traumatic pelvic fractures and to classify them correctly in terms of stability. Being familiar with typical concomitant injuries in pelvic ring fractures allows reliable diagnosis and their communication with the clinician. CT remains the “diagnostic workhorse”. In fragile pelvic fractures, the often prolonged course with fracture progression must be taken into account, which is why MRI is of particular importance herein.

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Literatur

  1. Pereira GJC, Damasceno ER, Dinhane DI et al (2017) Epidemiology of pelvic ring fractures and injuries. Rev Bras Ortop 52(3):260–269. https://doi.org/10.1016/j.rboe.2017.05.012

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gänsslen A, Pohlemann T, Paul CH et al (1996) Epidemiology of pelvic ring injuries. Injury 27(1):A13–20

    Google Scholar 

  3. Parreira JG, Coimbra R, Rasslan S et al (2000) The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures. Injury 31(9):677–682

    Google Scholar 

  4. Giannoudis PV, Grotz MRW, Tzioupis C et al (2007) Prevalence of pelvic fractures, associated injuries and mortality. The United Kingdom perspective. J Trauma 63:875–883

    PubMed  Google Scholar 

  5. Oberkircher L, Ruchholtz S, Rommens PM et al (2018) Osteoporotic pelvic fractures. Dtsch Arztebl Int 115(5):70–80. https://doi.org/10.3238/arztebl.2018.0070

    Article  PubMed  PubMed Central  Google Scholar 

  6. Yoshihara H, Yoneoka D (2014) Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality. J Trauma Acute Care Surg 76:380–385. https://doi.org/10.1097/TA.0b13e3182ab0cde

    Article  PubMed  Google Scholar 

  7. Andrich S, Haastert B, Neuhaus E et al (2015) Epidemiology of pelvic fractures in Germany: considerably high incidence rates among older people. PLoS ONE 10(9):e139078. https://doi.org/10.1371/journal.pone.0139078

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Maier GS, Kolbow K, Lazovic D et al (2016) Risk factors for pelvic insufficiency fractures and outcome after conservative therapy. Arch Gerontol Geriatr 67:80–85. https://doi.org/10.1016/j.archger.2016.06.020

    Article  PubMed  Google Scholar 

  9. Banierink H, ten Duis K, de Vries R et al (2019) Pelvic ring injury in the elderly: fragile patients with substantial mortality rates and long-term physical impairment. PLoS ONE 14(5):e216809. https://doi.org/10.1371/journal.pone.0216809

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Day AC, Kinomt C, Bircher MD et al (2007) Crescent-fracture dislocation of the sacroiliac joint: a functional classification. J Bone Joint Surg Br 89(5):651–658

    CAS  PubMed  Google Scholar 

  11. Fensky F, Weiser L, Sellenschloh K et al (2019) Biomechanical analysis of anterior pelvic ring fractures with intact peripelvic tissues: a cadaveric study. Eur J Trauma Emerg Surg. https://doi.org/10.1007/s00068-019-01213-2

    Article  PubMed  Google Scholar 

  12. Starr AJ, Nakatani T, Reinert CM et al (2008) Superior pubic ramus fractures fixed with percutaneous screws: what predicts fixation failure? J Orthop Trauma 22(2):81–87

    PubMed  Google Scholar 

  13. Culemann U, Scola A, Tosounidis G et al (2010) Versorgungskonzept der Beckenringverletzung des alten Patienten. Unfallchirurg 113(4):258–271. https://doi.org/10.1007/s0113-010-1762-3

    Article  CAS  PubMed  Google Scholar 

  14. Rommens PM, Hofmann A (2013) Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury 44(12):1733–1744. https://doi.org/10.1016/j.injury.2016.06.023

    Article  PubMed  Google Scholar 

  15. Gorczyca JT (2015) Biomechanics and methods of internal fixation. In: Tile M, Helfet DL, Kellam JF, Vrahas M (Hrsg) Fractures of the pelvis and Acetabulum, Bd. 1. Thieme, Davos-Stuttgart-New York, S 17–37

    Google Scholar 

  16. Rommens PM, Arand C, Thomczyk S et al (2019) Fragilitätsfrakturen des Beckens. Unfallchirurg. https://doi.org/10.1007/s00113-019-0643-7

    Article  PubMed  Google Scholar 

  17. Pennal GF, Sutherland GO (1961) Fractures of the pelvis. American Academy of Orthopaedic Surgeons Film Library, Park Ridge, IL

    Google Scholar 

  18. Vrahas M, Hearn TC, Angelo D et al (1999) Ligamentous contribution to pelvic ring stiffness. Orthopaedic Research Society Meeting, Anaheim, CA

    Google Scholar 

  19. Lefaivre K, O’Brien PJ, Tile M (2015) Pathoanatomy, mechanism of injury, and classification. In: Tile M, Helfet DL, Kellam JF, Vrahas M (Hrsg) Fractures of the pelvis and acetabulum, Bd. 1. Thieme, Davos-Stuttgart-New York, S 39–59

    Google Scholar 

  20. Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70(1):1–12

    CAS  PubMed  Google Scholar 

  21. Letournel E, Judet R (1981) Fractures of the acetabulum. Springer, New York

    Google Scholar 

  22. Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 227:67–81

    CAS  PubMed  Google Scholar 

  23. Roy-Camille R, Salliant G, Gagna G et al (1985) Transverse fracture of the upper sacrum : suicidal jumper’s fracture. Spine 10(9):838–845

    CAS  PubMed  Google Scholar 

  24. Burgess AR, Eastridge BJ, Young JW et al (1990) Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 30(7):848–856

    CAS  PubMed  Google Scholar 

  25. Koo H, Leveridge M, Thompson C et al (2008) Interobserver reliability for the Young-Burgess and Tile classification systems for fractures of the pelvic ring. J Orthop Trauma 22(6):379–384

    PubMed  Google Scholar 

  26. No authors listed (1996) Fracture and dislocation compendium. Orthopaedic trauma association committee for coding and classification. J Orthop Trauma 10(1):1–154

    Google Scholar 

  27. Guillamondegui OD, Mahboubi S, Stafford PW, Nance ML (2003) The utility of the pelvic radiograph in the assessment of pediatric pelvic fractures. J Trauma 55(2):236–240

    PubMed  Google Scholar 

  28. Hermans E, Cornelisse ST, Biert J et al (2017) Paediatric pelvic fractures: how do they differ from adults? J Child Orthop 11(1):49–56

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Resnik CS, Stackhouse DJ, Shanmuganathan K, Young JW (1992) Diagnosis of pelvic fractures in patients with acute pelvic trauma: efficiacy of plain radiographs. AJR Am J Roentgenol 158:109–112

    CAS  PubMed  Google Scholar 

  30. Schicho A, Schmidt SA, Seeber K et al (2016) Pelvic X‑ray misses out on detecting sacral fractures in the elderly—importance of CT imaging in blunt pelvic trauma. Injury 47(3):707–710

    PubMed  Google Scholar 

  31. Berg EE, Chebuhar C, Bell RM (1996) Pelvic trauma imaging: a blinded comparison of computed tomography and roentgenograms. J Trauma 41:994–998

    CAS  PubMed  Google Scholar 

  32. Holmes JF, Wisner DH (2012) Indications and performance of pelvic radiography in patients with blunt trauma. Am J Emerg Med 30(7):1129–1133

    PubMed  Google Scholar 

  33. Chmelová J, Mrázková D, Dzupa V et al (2006) The role of plain radiography in pelvic trauma in the era of advanced computed tomography. Acta Chir Orthop Traumatol Cech 73(6):394–399

    PubMed  Google Scholar 

  34. Zhang B‑F, Zhang H, Wang P‑F et al (2017) The role of ultrasonography in examination of the stability of Tile-B2 pelvic fractures. Medicine 96:38–43. https://doi.org/10.1097/MD.0000000000008100

    Article  Google Scholar 

  35. Jain S, Eedarapalli P, Jamjute P, Sawdy R (2006) Symphysis pubis dysfunction: a practical approach to management. (review). Obstet Gynecol 8:153–158. https://doi.org/10.1576/toag.8.3.153.27250

    Article  Google Scholar 

  36. Christian NT, Burlew CC, Moore EE et al (2018) The focused abdominal sonography for trauma examination can reliably identify patients with significant intra-abdominal hemorrhage in life-threatening pelvic fractures. J Trauma Acute Care Surg 84(6):924–928. https://doi.org/10.1097/TA.0000000000001838

    Article  PubMed  Google Scholar 

  37. Leone A, Cassar-Pullicino VN, Pérez MH, Guglielmi G (2017) Emergency and trauma of the pelvic ring. Semin Musculoskelet Radiol 21(3):210–217. https://doi.org/10.1055/s-0037-1602409

    Article  PubMed  Google Scholar 

  38. Falchi M, Rollandi GA (2004) CT of pelvic fractures. Eur J Radiol 50(1):96–105

    PubMed  Google Scholar 

  39. Herzog C, Ahle H, Mack MG et al (2004) Traumatic injuries of the pelvis and thoracic and lumbar spine: does thin-slice multidetector-row CT increase diagnostic accuracy? Eur Radiol 14(19):1751–1760

    CAS  PubMed  Google Scholar 

  40. Wedegartner U, Gatzka C, Rueger JM, Adam G (2003) Multislice CT (MSCT) in the detection and classification of pelvic and acetabular fractures. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 175(1):105–111

    CAS  PubMed  Google Scholar 

  41. Hallinan JT, Tan CH, Pua U (2014) Emergency computed tomography for acute pelvic trauma: where is the bleeder? Clin Radiol 69(5):529–537. https://doi.org/10.1016/j.crad.2013.12.016

    Article  CAS  PubMed  Google Scholar 

  42. Uyeda J, Anderson SW, Kertesz J, Soto JA (2010) Pelvic CT angiography: application to blunt trauma using 64MDCT. Emerg Radiol 17:131–137

    PubMed  Google Scholar 

  43. Anderson SW, Soto JA, Lucey BC et al (2008) Blunt trauma: feasibility and clinical utility of pelvic CT angiography performed with 64-detector row CT. Radiology 246(2):410–419

    PubMed  Google Scholar 

  44. Dreizin D, Bodanapally U, Boscak A et al (2018) CT prediction model for arterial injury after blunt pelvic ring disruption. Radiology 287(3):1061–1069

    PubMed  Google Scholar 

  45. Vaidya R, Waldron J, Scott A, Nasr K (2018) Angiography and embolization in the management of bleeding pelvic fractures. J Am Acad Orthop Surg 26:e68–e76. https://doi.org/10.5435/JAAOS-D-16-00600

    Article  PubMed  PubMed Central  Google Scholar 

  46. Barratt RC, Bernard J, Mundy AR, Greenwell TJ (2018) Pelvic fracture urethral injury in males—mechanism of injury, management options and outcomes. Transl Androl Urol 7(1):S29–S62. https://doi.org/10.21037/tau.2017.12.35

    Article  PubMed  PubMed Central  Google Scholar 

  47. Durrant JJ, Ramasamy A, Salmon MS et al (2013) Pelvic fracture-related urethral and bladder injury. J R Army Med Corps 159(1):32–39

    Google Scholar 

  48. Protzel C, Hakenberg OW (2010) Verletzungen des unteren Harntrakts und des Urogenitalsystems. Unfallchirurg 113:313–325. https://doi.org/10.1007/s00113-010-1766-z

    Article  CAS  PubMed  Google Scholar 

  49. Wu K, Posluszny JA Jr., Branch J et al (2015) Trauma for the pelvis: Injuries to the rectum and genitourinary organs. Curr Trauma Rep 1:8–15. https://doi.org/10.1007/s40719-014-0006-3

    Article  Google Scholar 

  50. Rodrigues-Pinto R, Kurd MF, Schroeder GD et al (2017) Sacral fractures and associated injuries. Global Spine J 7(7):609–616. https://doi.org/10.1177/2192568217701097

    Article  PubMed  PubMed Central  Google Scholar 

  51. Leonard M, Ibrahim M, McKenna P et al (2011) Paediatric pelvic ring fractures and associated injuries. Injury 42(19):1027–1030. https://doi.org/10.1016/j.injury.2010.08.005

    Article  PubMed  Google Scholar 

  52. Henes FO, Nüchtern JV, Groth M et al (2012) Comparison of diagnostic accuracy of magnetic resonance imaging and multidetector computed tomography in the detection of pelvic fractures. Eur J Radiol 81(9):2337–2342. https://doi.org/10.1016/j.ejrad.2011.07.012

    Article  CAS  PubMed  Google Scholar 

  53. Gary JL, Mulligan M, Banagan K et al (2014) Magnetic resonance imaging for the evaluation of ligamentous injury in the pelvis: a prospective case-controlled study. J Orthop Trauma 28(1):41–47. https://doi.org/10.1097/BOT.0b013e318299ce1b

    Article  PubMed  Google Scholar 

  54. Magu NK, Singla R, Gogna P et al (2013) Lumbar plexus injury in an anterior fracture dislocation of the sacroiliac joint: a case report and review of literature. Strategies Trauma Limb Reconstr 8(3):181–185. https://doi.org/10.1007/s11751-013-0177-4

    Article  PubMed  PubMed Central  Google Scholar 

  55. Mahajan R, Tandon V, Das K et al (2015) Management of neglected sacral fracture with cauda equnia syndrome: report of two cases with review of literature. Spinal Cord Ser Cases 1:15020. https://doi.org/10.1038/scsandc.2015.20

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Nüchtern JV, Hartel MJ, Henes FO et al (2015) Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures. Injury 46(2):315–319. https://doi.org/10.1016/j.injury.2014.10.050

    Article  PubMed  Google Scholar 

  57. Lang P, Merz C, Hackenbroch C et al (2019) Magnetic resonance imaging in pelvic fractures—part 1: which criteria lead us to supplementary MRI diagnostics? Z Orthop Unfall. https://doi.org/10.1055/a-0965-7589

    Article  PubMed  Google Scholar 

  58. Palm HG, Lang P, Hackenbroch C et al (2019) Dual-energy CT as an innovative method for diagnosing fragility fractures of the pelvic ring: a retrospective comparison with MRI as the gold standard. Arch Orthop Trauma Surg. https://doi.org/10.1007/s004402-019-03283-8

    Article  PubMed  Google Scholar 

  59. Hackenbroch C, Riesner HJ, Lang P et al (2017) Dual energy computed tomography in musculoskeletal imaging, with focus on fragility fractures of the pelvis. Z Orthop Unfall 155(6):708–715. https://doi.org/10.1055/s-0043-117738

    Article  PubMed  Google Scholar 

  60. Stephen DJ, Kreder HJ, Day AC et al (1999) Early detection of arterial bleeding in acute pelvic trauma. J Trauma 47(4):638–642

    CAS  PubMed  Google Scholar 

  61. Wijffels DJ, Verbeek DO, Ponsen KJ et al (2019) Imaging and endovascular treatment of bleeding pelvic fractures: review article. Cardiovasc Intervent Radiol 42:10–18. https://doi.org/10.1007/s00270-018-2071-4

    Article  PubMed  Google Scholar 

  62. Romano L, Pinto A, Niola R et al (2012) Bleeding due to pelvic fractures in female patients: pictorial review of multidetector computed tomography imaging. Curr Probl Diagn Radiol 41(3):83–92. https://doi.org/10.1067/.cpradiol.2011.07.006

    Article  PubMed  Google Scholar 

  63. Skitch S, Engels PT (2018) Acute management of the traumatically injured pelvis. Emerg Med Clin North Am 36(1):161–178. https://doi.org/10.1016/j.emc.2017.08.011

    Article  PubMed  Google Scholar 

  64. Scheyerer MJ, Hüllner M, Pietsch C et al (2015) Evaluation of pelvic ring injuries using SPECT/CT. Skeletal Radiol 44(2):217–222. https://doi.org/10.1007/s00256-014-1971

    Article  PubMed  Google Scholar 

  65. Scheyerer MJ, Pietsch C, Zimmermann SM et al (2014) SPECT/CT for imaging of the spine and pelvis in clinical routine: a physician’s perspective of the adoption of SPECT/CT in a clinical setting with the focus on trauma surgery. Eur J Nucl Med Mol Imaging 41(1):S59–S66

    PubMed  Google Scholar 

  66. Aparisi Gómez MP (2016) Nonspinal fragility fractures. Semin Musculoskelet Radiol 20(4):330–344

    PubMed  Google Scholar 

  67. Martin L, Ruddlesden R, Makepeace C et al (2013) Paediatric x‑ray radiation dose reduction and image quality analysis. J Radiol Prot 33(3):621–633

    CAS  PubMed  Google Scholar 

  68. Diviti S, Gupta N, Hooda K et al (2017) Morel-Lavallee lesions—review of pathophysiology, clinical findings, imaging findings and management. J Clin Diagn Res 11(4):TE1–TE4

    PubMed  PubMed Central  Google Scholar 

  69. Fuchs T, Rottbeck U, Hofbauer V et al (2011) Beckenringfrakturen im Alter. Eine unterschätzte osteoporotische Fraktur. Unfallchirurg 114(8):663–670. https://doi.org/10.1007/s00113-011-2020-z

    Article  CAS  PubMed  Google Scholar 

  70. Mallinson PI, Coupal TM, McLaughlin PD et al (2016) Dual-energy CT for the musculoskeletal system. Radiology 281(3):690–707

    PubMed  Google Scholar 

  71. Schegerer A, Loose R, Heuser LJ, Brix G (2019) Diagnostische Referenzwerte für diagnostische und interventionelle Röntgenanwendungenin Deutschland: Aktualisierung und Handhabung. Fortschr Röntgenstr. https://doi.org/10.1055/a-0824-7603

    Article  Google Scholar 

  72. Tosounidis G, Wirbel R, Culemann U, Pohlemann T (2006) Fehleinschätzung bei vorderer Beckenringfraktur im höheren Lebensalter. Unfallchirurg 109(8):678–680

    CAS  PubMed  Google Scholar 

  73. Böhme J, Höch A, Boldt A, Josten C (2012) Einfluss der Standard-Computertomografie hinsichtlich Frakturklassifikation und Therapie von Beckenringfrakturen bei Patienten über dem 65. Lebensjahr. Z Orthop Unfall 150(5):477–483. https://doi.org/10.1055/s-0032-1315270

    Article  PubMed  Google Scholar 

  74. Krappinger D, Kaser V, Kammerlander C et al (2019) Inter- and intraobserver reliability and critical analysis of the FFP classification of osteoporotic pelvic ring injuries. Injury 50(2):337–343. https://doi.org/10.1016/j.injury.2018.11.027

    Article  PubMed  Google Scholar 

  75. Hackenbroch C, Merz C, Palm HG et al (2019) Magnetic resonance imaging in pelvic fractures—part 2: gaining information and clinical therapeutic relevance. Z Orthop Unfall. https://doi.org/10.1055/a-0965-7686

    Article  PubMed  Google Scholar 

  76. Rommens PM, Arand C, Hopf JC et al (2019) Progress of instability in fragility fractures of the pelvis: an observational study. Injury. https://doi.org/10.1016/j.injury.2019.08.038

    Article  PubMed  Google Scholar 

  77. Kloth JK, Neumann R, von Stillfried E et al (2016) Quality-controlled dose-reduction of pelvic examinations in infants with hip dysplasia. Eur J Radiol 85(1):233–238

    PubMed  Google Scholar 

  78. Rostad BS, Applegate KE, Kim T et al (2018) Multiphase acquisitions in pediatric abdominal-pelvic CT are a common practice and contribute to unnecessary radiation dose. Pediatr Radiol 48(12):1714–1723

    PubMed  Google Scholar 

  79. Yi JW, Park HJ, Lee SY et al (2017) Radiation dose reduction in multidetector CT in fracture evaluation. Br J Radiol 90(1077):20170240. https://doi.org/10.1259/bjr.20170240

    Article  PubMed  PubMed Central  Google Scholar 

  80. Geyer LL, Koerner M, Wirth S et al (2013) Polytrauma: optimal imaging and evaluation algorithm. Semin Musculoskelet Radiol 17(4):371–379. https://doi.org/10.1055/s-0033-1356466

    Article  PubMed  Google Scholar 

  81. Misiura AK, Nanassy AD, Urbine J (2018) Usefulness of pelvic radiographs in the initial trauma evaluation with concurrent CT: Is additional radiation exposure necessary? Int J Pediatr. https://doi.org/10.1155/2018/6260954

    Article  PubMed  PubMed Central  Google Scholar 

  82. Bauman M, Marinaro J, Crandall CS et al (2009) Ultrasonographic determination of pubic symphyseal widening in trauma: the FAST-PS study. J Emerg Med 40(5):528–533

    PubMed  Google Scholar 

  83. Hamilton JD, Kumaravel M, Censullo ML et al (2008) Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 28(6):1603–1616. https://doi.org/10.1148/rg.286085522

    Article  PubMed  Google Scholar 

  84. Raninga SB, Mittal AK, Bernstein M et al (2019) Multidetector CT in vascular injuries resulting from pelvic fractures: a primer for diagnostic radiologists. Radiographics 39(7):2111–2119. https://doi.org/10.1148/rg.2019190062

    Article  Google Scholar 

  85. Hans FJ, Reinges MH, Krings T (2004) Lumbar nerve root avulsion following trauma: balanced fast field-echo MRI. Neuroradiology 46(2):144–147

    CAS  PubMed  Google Scholar 

  86. Neufeld EA, Shen PY, Nidecker AE et al (2015) MR imaging of the lumbosacral plexus: a review of techniques and pathologies. J Neuroimaging 25(5):691–703. https://doi.org/10.1111/jon.12253

    Article  PubMed  Google Scholar 

  87. Robbins NM, Shah V, Benedetti N et al (2016) Magnetic resonance neurography in the diagnosis of neuropathies of the lumbosacral plexus: a pictorial review. Clin Imaging 40(6):1118–1130. https://doi.org/10.1016/j.clinimag.2016.07.003

    Article  PubMed  Google Scholar 

  88. Ramchandani P, Buckler PM (2009) Imaging of genitourinary trauma. AJR Am J Roentgenol 192:1514–1523. https://doi.org/10.2214/AJR.09.2470

    Article  PubMed  Google Scholar 

  89. Bryant WK, Shewakramani S (2017) Emergency management of renal and genitourinary trauma: best practices update. Emerg Med Pract 19(8):1–20

    PubMed  Google Scholar 

  90. Dane B, Baxter AB, Bernstein MP (2017) Imaging genitourinary trauma. Radiol Clin North Am 55(2):321–335. https://doi.org/10.1016/j.rci.2016.10.007

    Article  PubMed  Google Scholar 

  91. Govaert G, Siriwardhane M, Hatzifotis M et al (2012) Prevention of pelvic sepsis in major open pelviperineal injury. Injury 43(4):533–536. https://doi.org/10.1016/j.injury.2011.12.002

    Article  PubMed  Google Scholar 

  92. Zong Z‑W, Bao Q‑W, Liu H‑Y et al (2016) Diagnosis and treatment of rare complications of pelvic fractures. Chin J Traumatol 19:199–205. https://doi.org/10.1016/j.cjtee.2015.12.012

    Article  PubMed  PubMed Central  Google Scholar 

  93. Hegazi TM, Belair JA, McCarthy EJ et al (2016) Sports injuries about the hip: what the radiologist should know. Radiographics 36(6):1717–1745

    PubMed  Google Scholar 

  94. Buyukkaya A, Günes H, Özel MA et al (2015) Lumbar Morel-Lavallée lesion after trauma: a report of 2 cases. Am J Emerg Med 33(8):1116.e5–1116.e6. https://doi.org/10.1016/j.ajem.2015.01.043

    Article  Google Scholar 

  95. Kido A, Yoshida S, Shimoda E et al (2016) Walking disability in patients with pelvic insufficiency fracture after radiotherapy for uterine cervical cancer. Prog Rehabil Med. https://doi.org/10.2490/prm20160009

    Article  PubMed  PubMed Central  Google Scholar 

  96. Gervaise A, Osemont B, Louis M et al (2014) Standard dose versus low-dose abdominal and pelvic CT: comparison between filtered back projection versus adaptive iterative dose reduction 3D. Diagn Interv Imaging 95(1):47–53. https://doi.org/10.1016/j.diii.2013.05.005

    Article  CAS  PubMed  Google Scholar 

  97. Pfeifer R, Pape HC (2008) Missed injuries in trauma patients: a literature review. Patient Saf Surg 23(2):20. https://doi.org/10.1186/1754-9493-3-20

    Article  Google Scholar 

  98. Lefaivre K et al (2015) Pathoanatomy, mechanisms of injury, and classification. In: Tile M, Helfet DL, Kellam JF, Vrahas M (Hrsg) Fractures of the pelvis and acetabulum, Bd. 1. Thieme, Stuttgart, S 51–53

    Google Scholar 

  99. Weaver MJ, Heng M (2015) Orthopedic approach to the early management of pelvic injuries. Curr Trauma Rep 1:16–25

    Google Scholar 

  100. Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70(1):1–12

    CAS  PubMed  Google Scholar 

  101. Rommens PM et al (2015) J Orthop Sci 20(1):1–11

    PubMed  Google Scholar 

  102. Spering C, Lehmann W (2019) Therapiekonzepte bei Beckenringverletzungen. Orthop Unfallchir up2date 14:359–377

    Google Scholar 

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Danksagung

Der Autor dankt ausdrücklich den Herren Professor Dr. Dr. Edgar Mayr, Direktor der Klinik für Unfallchirurgie, Orthopädie, plastische und Handchirurgie am Universitätsklinikum Augsburg, und Professor Dr. Dr. Stefan Wirth, Chefarzt der Radiologie am Donau-Isar-Klinikum Deggendorf, für ihre sorgfältige Manuskriptdurchsicht und die wertvollen Anregungen zum Thema.

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  1. Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland

    Thomas Grieser

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Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Grieser, T. Radiologische Diagnostik von Beckenringfrakturen. Radiologe 60, 226–246 (2020). https://doi.org/10.1007/s00117-020-00656-8

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