Preliminary trauma radiographs misrepresent pubic diastasis injuries

Area of Science:

• Orthopedic Surgery
• Radiology
• Trauma Care

Background:

• Anteroposterior (AP) compression pelvic injuries require accurate assessment for appropriate management.
• Portable primary trauma survey radiographs are often the initial imaging modality used in trauma settings.

Purpose of the Study:

• To evaluate the diagnostic accuracy of portable pelvic radiographs compared to pelvic CT scans in assessing AP compression pelvic injuries.
• To determine if portable radiographs influence treatment decisions for pelvic ring injuries.

Main Methods:

• Retrospective analysis of 27 adult patients with AP pelvic ring injuries.
• Comparison of diastasis measurements between portable pelvic radiographs and pelvic CT scans.
• Assessment of intraobserver and interobserver reliability for measurements.

Main Results:

• Portable radiographs overestimated pelvic diastasis by an average of 49% (12.6 mm) compared to CT scans.
• Portable films were less precise than standard radiographs in measuring femoral head size.
• In 12 patients, portable radiographs indicated surgery, while CT scans did not; 11 of these underwent surgery.

Conclusions:

• Portable AP pelvic radiographs can distort and exaggerate pelvic bony injuries.
• Management decisions based solely on preliminary portable pelvic radiographs require caution.
• CT imaging provides a more accurate assessment for operative planning in AP pelvic injuries.