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Pelvic Trauma: Bone

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Diagnostic Imaging in Polytrauma Patients

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Abstract

Pelvic ring fractures are a common consequence of high-energy blunt trauma, as may result from motor vehicle collisions and work-related falls from great height or crushing, and occur in younger adults. A constantly rising number of pelvic fractures have also been observed. The seriousness of pelvic fractures lies in the high rates of morbidity and mortality due to accompanying injuries associated with other organ systems, particularly vascular and visceral structures. Improvements in outcome depend on management of patients with pelvic ring fractures: the appropriate treatment depends upon a thorough knowledge of pelvic anatomy and biomechanics and understanding of the various types of lesions. Use of a classification system of pelvic fractures based on force vectors provides a logical approach to the multidisciplinary management of pelvic ring disruption (PRD) and allows early and aggressive treatment. Advantages of a “restitutio ad integrum” of normal pelvic anatomy, in a young population, offer a fast operative recovery that avoids probable complication due to a long period in bed. Diagnostic imaging should be considered the key to understand the mechanism of injury. Computed tomography (CT) is the technique of choice in the management of polytraumatized patients. Multi-planar reconstruction (MPR) and volume-rendering (VR) three-dimensional (3D) reconstruction views, reproducing radiological standard representations and oblique projections, are powerful modalities in classifying the various types of fractures and the mechanism and severity of injury. The pelvic bone is an anatomically complex tridimensional, ringlike structure, and for this reason, the integration of the information amongst axial, bi-, and three-dimensional images appears to be fundamental and eliminates any interpretive problems to understand the anatomy of the pelvis in all its aspects, and exactly detect the fracture sites, especially in complex cases. Three-dimensional reconstruction views are a kind of ideal conjunction between the traditional information gained from the radiographic images and axial CT scans.

The analysis of fracture morphology necessary for understanding the failure mechanisms is a very useful tool also for assessing the possible presence of vascular, visceral, or nervous complications and for emphasizing the key role of the radiologist in the management of polytrauma patient.Understanding of underlying injury mechanisms and treatment concepts of pelvic ring injuries represents the ‘key’ to successful management strategies for high-energy pelvic injuries.

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Authors and Affiliations

  1. Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy

    Michele Galluzzo M.D., Francesco Gaudino, Grazia Loretta Buquicchio & Margherita Trinci

  2. Department of Radiology, Careggi University Hospital, Florence, Italy

    Gloria Addeo, Ginevra Danti & Vittorio Miele

Authors
  1. Michele Galluzzo M.D.
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  2. Francesco Gaudino
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  3. Gloria Addeo
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  4. Grazia Loretta Buquicchio
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  5. Ginevra Danti
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  6. Margherita Trinci
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  7. Vittorio Miele
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Correspondence to Michele Galluzzo M.D. .

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Editors and Affiliations

  1. Department of Radiology, Careggi University Hospital, Florence, Italy

    Vittorio Miele

  2. Dept of Emergency Radiology, S. Camillo Hospital, Rome, Italy

    Margherita Trinci

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Galluzzo, M. et al. (2018). Pelvic Trauma: Bone. In: Miele, V., Trinci, M. (eds) Diagnostic Imaging in Polytrauma Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-62054-1_20

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  • DOI: https://doi.org/10.1007/978-3-319-62054-1_20

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