This week’s radiology review focused on Pelvic Ring Fractures. Again, it’s only a 5-minute review so we dedicated it to the AP view. However, in a detailed work-up, additional views (including inlet/outlet and likely CT) will be obtained.
Quick Review of AP Pelvic Xray
Classifying Pelvic Ring Fractures
— As is anything in Emergency Medicine, start with the basics. Is the pt hemodynamically stable or unstable? The pelvis is notorious for being able to hide blood. Also it is important to do a thorough secondary survey as these injuries are associated with high energy blunt trauma, and secondary injuries can be missed. For instance, pelvic ring fractures were associated with chest injury in 63% of cases, long bone fractures in 50% of cases, head and abdominal injury in 40% of cases, and spine fractures in 25% of cases (Orthobullets).
— Is the fracture stable vs. unstable? There are two classification systems that can be used (Tile Classification vs. Young-Burgess Classification) with the end goal of determining the stability and severity of the fracture. The Young-Burgess is used more commonly (reviewed below) and divides fractures by mechanism (Lateral Compression, Anteroposterior compression, and Vertical Shear)
Types of Fractures
- Lateral Compression Fracture (LC)
— Often seen in T-bone MVC or pedestrian hit from side
— Typically, Rami Fracture with ipsilateral iliac fracture.
— Most common Pelvic Ring Fracture.
- Anteroposterior Compression (APC)
— Often from head-on-collision MVC
— Symphysis widening. >2.5 cm is a more unstable fracture that often requires fixation surgery. May also have associated SI joint diastasis as well as disruption of SI ligaments
— These are the patients that present with hypotension. This is due to the mechanism that causes the iliac wings to be forced outward allowing for increased pelvic volume
- Vertical Shear
— Results from vertically oriented force. Most often fall from great height (e.g. fall from building onto legs)
Young Burgess Classification System
And as promised… For all the people that really want to get in the weeds, The Young Burgess Classification System. I love that vertical shear is not further divided by severity as it implies badness.
Fun Medical History
I really enjoy medical history, and it’s my goal to share at least a small piece of medical history at the end of each post. I actually learned this piece of trivia from Dr. Somy Thottathil. This past week we celebrated the 47th anniversary of the first CT scan ever. It took place on October 1, 1971, in Wimbledon, London. It was performed by the scientist Sir Godfrey Hounsfield (yep, of Hounsfield unit fame)–pictured below. It was only designed for brain imaging, and in this first Head CT, revealed a brain tumor in a 41-year-old female. In another 4 years, the first whole-body CT scanner was developed.
Additional fun fact–the development of this first CT scanner is partially owed to the Beatles. Hounsfield was part of the EMI company, which was the same company that owned The Beatles’ music. The profits from their music helped to fund this research.