pelvis plain film of the trauma patient –...

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Pelvis plain film of the trauma patient Pelvis plain film of the trauma patient –– Any utility?Any utility?

Johan C HellundJohan C HellundDept of radiologyDept of radiology

UllevalUlleval University HospitalUniversity Hospital

The The answeranswer: :

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WhyWhy yesyes ??

•• Trauma Trauma triagetriage–– AA–– BB–– CC

WhyWhy yesyes ??

•• Trauma triageTrauma triage–– AirwaysAirways–– BreathingBreathing–– CirculationCirculation

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WhyWhy yesyes ??


•• In radiologic terms:In radiologic terms:•• Chest XChest X--rayray

WhyWhy yesyes ??


•• In radiologic terms:In radiologic terms:•• Chest XChest X--rayray•• Pelvic plain filmPelvic plain film

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WhyWhy yesyes ??


•• In radiologic terms:In radiologic terms:•• Chest XChest X--rayray•• Pelvic plain filmPelvic plain film

–– Signs of FACTURES / TORN LIGAMENTS?Signs of FACTURES / TORN LIGAMENTS?-- indicating possible indicating possible haemorrhagehaemorrhage

Bleeding due to:Bleeding due to:

•• Pelvis ring Pelvis ring damagedamage•• AcetabularAcetabular fracturesfractures•• OtherOther fracturesfractures

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Focus on !!Focus on !!

•• Forces on the pelvis Forces on the pelvis –– type of trauma type of trauma

•• Normal findings Normal findings -- checkpointscheckpoints

•• ““What you donWhat you don’’t seet see””

Forces on the pelvisForces on the pelvis

•• AnteriorposteriorAnteriorposteriorcompressioncompression

•• Lateral Lateral compressioncompression

•• Vertical Vertical shearshear

•• Combination these 3Combination these 3of forcesof forces

•• (Forces acting on the (Forces acting on the acetabulumacetabulum))

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CheckpointsCheckpoints•• 3 bony rings3 bony rings

–– Pelvis brimPelvis brim–– ObturatorObturator foraminaforamina

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Disrupted bony ringsDisrupted bony rings

One fx in a bony ring is associated with a second fx!!

??

CheckpointsCheckpoints

•• Alignment of theAlignment of the–– SacroliacSacroliac jointsjoints–– Pubic Pubic symphysissymphysis–– ArcuateArcuate lines lines

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AP AP forceforce –– ””OpenOpen bookbook””


•• Alignment of theAlignment of the–– SacroliacSacroliac jointsjoints–– Pubic Pubic symphysissymphysis–– ArcuateArcuate lineslines

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WideningWidening ofof thethe symphysissymphysis


•• Alignment of theAlignment of the–– SacroliacSacroliac jointsjoints–– Pubic Pubic symphysissymphysis–– ArcuateArcuate lineslines

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FracturedFractured arcuatearcuate lines lines


•• Alignment !!Alignment !!

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•• AcetabulumAcetabulum–– Posterior and anterior brimPosterior and anterior brim–– the Tear dropthe Tear drop

•• L5L5•• Hip fractureHip fracture

–– ShentonShenton’’ss lineline


•• AcetabulumAcetabulum–– PosteriorPosterior and anterior and anterior brimbrim–– the Tear dropthe Tear drop



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•• AcetabulumAcetabulum–– Posterior and anterior brimPosterior and anterior brim–– the the Tear dropTear drop







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–– ShentonShenton’’ss lineline•• Disrupted Disrupted obturatorobturator ring?ring?

AcetabulumAcetabulum –– posterior brimposterior brim

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AcetabulumAcetabulum + ring + sacrum+ ring + sacrum

L5 L5 fxfx and and disrupteddisrupted ring (+ hip ring (+ hip fxfx))

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Vertical shear injuryVertical shear injury

DisruptedDisrupted ShentonShenton’’ss lineline

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DislocatedDislocated hiphip

““What you donWhat you don’’t seet see””

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Sacral fractures

- Horizontal

““What you donWhat you don’’t t see on a pelvic see on a pelvic APAP--filmfilm””

Take home messageTake home message

•• Pelvis plain film is part of trauma triagePelvis plain film is part of trauma triage

•• Try to identify the forces acting on the pelvis Try to identify the forces acting on the pelvis

•• Inspect the bony rings, the alignment and L5Inspect the bony rings, the alignment and L5

•• Sacral fractures difficult to see (horizontal)Sacral fractures difficult to see (horizontal)

pelvis plain film of the trauma patient –...

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