JOURNAL READING

Pelvic X-ray misses out on detec4ng sacral fractures

in the elderly – Importance of CT imaging in blunt pelvic trauma

Yuriko Wada
202106010024
Advisor
dr. Maissie Johan, SpRad
Introduc)on
• Blunt pelvic trauma are a common complaint among elderly patients.
• Xray à fails to detect sacral fractures à gas and bowel projections,
degenerative bony alterations à interventional therapeutical
relevance
MATERIALS AND METHODS
• All radiological reports for patients aged 75 years older who had a blunt
trauma and had both a standard A.P. pelvic X-ray and pelvic CT scan in the
emergency department over a 3-year period in our German level I trauma
center
• Patients with only either X-ray or CT scan were disregarded, and histories of
inadequate (no direct blow to the pelvis or hip) or missing trauma were
excluded.
• Age and gender were recorded, and cases were analysed overall and
according to the following age groups 76–80, 81–85, 86–90, 91–95 and 96+
• The intrinsic test characteristics (sensitivity and specificity) and the
performance in the selected population (positive and negative predictive
values) were calculated according to standard formulas
RESULT
• N = 233
• 227 showed no sacral
fracture. 51 (21.7%) of
these were false negaEve
and just 1 X-ray was false
posiEve.
• Thereof, 56 (24%) showed
a sacral fracture in the CT
scan.
RESULT
• N = 233
• 28 a fracture of the pubic
bone was suspected with
115 being correct positive
and 13 being false
positive.
• CT scan revealed 175
fractures, making 60
radiographs being false
negative and 121 correct
negative.
RESULT
• Mean age = 85.1 ± 6.1 years
• 88% being female
• mean ASA = 3.2
• Mean body height = 1.62 cm
• Mean body weight = 59.2 kg
• Mean BMI = 22.5
• Mean length of
hospitalisasion = 11.8 days
DISCUSSION
• Bad imaging techniquewrong exposure time or voltage have to be
improved.
• Gas and bowel overlay makes the sacrum hard to evaluate
• Osteochondrotic and osteoporotic changes of the bone texture can
cover up damages, even of the cortical bone.
• The patient is not able to give proper signs in clinical examination or
anamnesis, which both are of importance at the edge of diagnostics.
DISCUSSION
• In 2012, Scheyerer et al. reported an enormous 96.8% of posterior
pelvic ring fractures being missed in paEents with diagnosed fracture
of the pubic rami
• Nu c̈ htern et al., in a pre-selected populaEon with anterior pelvic ring
fractures, in 80% a posterior ring lesion was finally found using MRI
• Berg et al reported a low detecEon rate of posterior pelvic ring
fractures in plain A.P.-radiographs with 47% of injuries being missed
• With decreasing examinaEon Eme and cost, computed tomography is
becoming a standard procedure with increasing frequency and
indicaEons
DIAGNOSTIC PATHWAY

Fig. 3. Diagnostic algorithm for blunt pelvic trauma in patients aged 75 years and older. Suspected injuries of the pelvic ring
after clinical examination (CE) should be addressed by a.p. X-ray, being aware of the low detection rate of posterior lesions.
Inadequate mobilisation needs further diagnostic work up, either by CT following conventional X-ray, or by MRI following CT.
CONCLUSION
The use of pelvic CT scans in the population aged 75 years and older
should be used whenever the findings are relevant for therapeutic
decision making
THANK YOU