Multitrauma patients can have serious injuries that may be readily apparent or occult. Unstable pelvic fractures may be difficult to diagnose with physical examination alone. Therefore, radiographic evaluation is critical in evaluating the bony pelvis. Radiographs are the primary initial imaging modality. In the open-book pelvis, it is important to evaluate the sacroiliac joints and pubic symphysis for diastasis. In addition, a thorough evaluation should be performed for possible fractures. If there is any suspicion of pelvic injury on radiographs, CT scan of the pelvis is indicated. Computed tomography is the most accurate method for evaluating pelvic injuries and can be used for preoperative planning. Also, CT can demonstrate visceral and vascular injuries. If there is active pelvic hemorrhage and/or the patient is unstable with no other injuries to account for blood loss, urgent stabilization and angiography to identify bleeding vessels and embolization of bleeding vessels can be completed to achieve hemodynamic control. If urethral injury is possible, a retrograde urethrogram is necessary for further evaluation and before catheterizing the bladder. The information provided by these imaging modalities may prove critical to management of patients with open-book injuries of the pelvis.
ASJC Scopus subject areas
- Orthopedics and Sports Medicine