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Evaluation of pelvic ring injuries using SPECT/CT

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Abstract

Objective

The incidence of pelvic fractures is relatively low compared with other fracture locations. The low incidence is in great contrast to the high morbidity and mortality. Particularly in the elderly, with apparently isolated fractures of the pubic rami, these observations are believed to be due to additional occult lesions of the posterior pelvic ring. In these cases diagnosis cannot be established by conventional imaging alone and SPECT/CT is considered as a diagnostic adjunct. The aim of this study was to assess concomitant bony or soft tissue lesions within the pelvic ring in a population of patients with fractures of the anterior elements.

Materials and methods

In all patients with no obvious lesions of the posterior pelvic ring on X-rays and CT or with suspicious but inconclusive findings on CT an additional SPECT/CT was carried out in a non-acute setting within 3 days of the trauma.

Results

In all cases additional lesions within the pelvic ring were found. Most lesions were vertical sacral fractures, followed by transverse fractures, one non-dislocated fracture of the acetabulum on the side of the pubic rami fracture, and one post-traumatic dilatation of the sacroiliac joint with increased tracer uptake.

Conclusion

According to our results after SPECT/CT all patients with pubic rami fracture suffered additional lesions, none detectable previously by X-ray or CT, within the pelvic ring. In this context SPECT/CT has proved to be very helpful in the clinical routine to visualize occult fractures and instability within the sacroiliac joint.

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References

  1. Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury. 2004;35:671–7.

    Article  CAS  PubMed  Google Scholar 

  2. Grotz MR, Allami MK, Harwood P, Pape HC, Krettek C, Giannoudis PV. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury. 2005;36:1–13.

    Article  CAS  PubMed  Google Scholar 

  3. Hill RM, Robinson CM, Keating JF. Fractures of the pubic rami. Epidemiology and five-year survival. J Bone Joint Surg (Br). 2001;83:1141–4.

    Article  CAS  Google Scholar 

  4. Koval KJ, Aharonoff GB, Schwartz MC, Alpert S, Cohen G, McShinawy A, et al. Pubic rami fracture: a benign pelvic injury? J Orthop Trauma. 1997;11:7–9.

    Article  CAS  PubMed  Google Scholar 

  5. Van Dijk WA, Poeze M, van Helden SH, Brink PR, Verbruggen JP. Ten-year mortality among hospitalised patients with fractures of the pubic rami. Injury. 2010;41:411–4.

    Article  PubMed  Google Scholar 

  6. Breuil V, Roux CH, Testa J, Albert C, Chassang M, Brocq O, et al. Outcome of osteoporotic pelvic fractures: an underestimated severity. Survey of 60 cases. Joint Bone Spine. 2008;75:585–8.

    Article  PubMed  Google Scholar 

  7. Gertzbein SD, Chenoweth DR. Occult injuries of the pelvic ring. Clin Orthop Relat Res. 1977;128:202–7.

    PubMed  Google Scholar 

  8. Isler B, Ganz R. Classification of pelvic ring injuries. Injury. 1996;27(1):3–12.

    Article  Google Scholar 

  9. Scheyerer MJ, Osterhoff G, Wehrle S, Wanner GA, Simmen HP, Werner CM. Detection of posterior pelvic injuries in fractures of the pubic rami. Injury. 2012;43:1326–9.

    Article  PubMed  Google Scholar 

  10. Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 2002;195:1–10.

    Article  PubMed  Google Scholar 

  11. Gilliland MD, Ward RE, Barton RM, Miller PW, Duke JH. Factors affecting mortality in pelvic fractures. J Trauma. 1982;22:691–3.

    Article  CAS  PubMed  Google Scholar 

  12. Pohlemann T, Tscherne H, Baumgartel F, Egbers HJ, Euler E, Maurer F, et al. [Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group]. Unfallchirurg. 1996;99:160–7.

    Article  CAS  PubMed  Google Scholar 

  13. Poole GV, Ward EF. Causes of mortality in patients with pelvic fractures. Orthopedics. 1994;17:691–6.

    CAS  PubMed  Google Scholar 

  14. Smith W, Williams A, Agudelo J, Shannon M, Morgan S, Stahel P, et al. Early predictors of mortality in hemodynamically unstable pelvis fractures. J Orthop Trauma. 2007;21:31–7.

    Article  PubMed  Google Scholar 

  15. Gansslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury. 1996;27(1):13–20.

    Article  Google Scholar 

  16. Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop Relat Res. 1980;151:12–21.

    PubMed  Google Scholar 

  17. Obaid AK, Barleben A, Porral D, Lush S, Cinat M. Utility of plain film pelvic radiographs in blunt trauma patients in the emergency department. Am Surg. 2006;72:951–4.

    PubMed  Google Scholar 

  18. Guillamondegui OD, Pryor JP, Gracias VH, Gupta R, Reilly PM, Schwab CW. Pelvic radiography in blunt trauma resuscitation: a diminishing role. J Trauma. 2002;53:1043–7.

    Article  PubMed  Google Scholar 

  19. Hilty MP, Behrendt I, Benneker LM, Martinolli L, Stoupis C, Buggy DJ, et al. Pelvic radiography in ATLS algorithms: A diminishing role? World J Emerg Surg. 2008;3:11.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Kessel B, Sevi R, Jeroukhimov I, Kalganov A, Khashan T, Ashkenazi I, et al. Is routine portable pelvic X-ray in stable multiple trauma patients always justified in a high technology era? Injury. 2007;38:559–63.

    Article  PubMed  Google Scholar 

  21. Konala P, Iranpour F, Kerner A, Rasch H, Friederich NF, Hirschmann MT. Clinical benefit of SPECT/CT for follow-up of surgical treatment of osteochondritis dissecans. Ann Nucl Med. 2010;24:621–4.

    Article  PubMed  Google Scholar 

  22. Welsch M, Welsch F, Grunwald F. [Nuclear medicine techniques in the diagnosis of orthopaedic diseases]. Orthopade. 2006;35(632–40):42–3.

    Google Scholar 

  23. Love C, Din AS, Tomas MB, Kalapparambath TP, Palestro CJ. Radionuclide bone imaging: an illustrative review. Radiographics. 2003;23:341–58.

    Article  PubMed  Google Scholar 

  24. Palestro CJ, Love C, Schneider R. The evolution of nuclear medicine and the musculoskeletal system. Radiol Clin North Am. 2009;47:505–32.

    Article  PubMed  Google Scholar 

  25. Buckley SL, Burkus JK. Computerized axial tomography of pelvic ring fractures. J Trauma. 1987;27:496–502.

    Article  CAS  PubMed  Google Scholar 

  26. Hoffmeyer P, Seigne JM, Garcia J, Vasey H. The value of computerized tomography in fractures of the pelvic ring. Int Orthop. 1984;8:1–8.

    Article  CAS  PubMed  Google Scholar 

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Disclosures

Patrick Veit-Haibach received IIS grants from Bayer Healthcare and Siemens Medical Solutions and speakers fees from GE Healthcare.

Conflict of interest

No other conflicts of interest exist.

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Authors and Affiliations

  1. Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Max J. Scheyerer & Clement M. L. Werner

  2. Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Zurich, Switzerland

    Martin Hüllner, Carsten Pietsch & Patrick Veit-Haibach

  3. Diagnostic and Interventional Radiology, Department of Medical Radiology, University Hospital Zurich, Zurich, Switzerland

    Patrick Veit-Haibach

  4. Centre for Orthopaedic and Trauma Surgery, University Medical Center, Josef Stelzmann Str. 9, Cologne, 50924, Germany

    Max J. Scheyerer

Authors
  1. Max J. Scheyerer
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  2. Martin Hüllner
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  3. Carsten Pietsch
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  4. Clement M. L. Werner
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  5. Patrick Veit-Haibach
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Correspondence to Max J. Scheyerer.

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

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  • DOI: https://doi.org/10.1007/s00256-014-1971-x

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