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Updated: Feb 28, 2026
Assessment of Bone Fracture Healing Using Micro-Computed Tomography
Published on: December 9, 2022
Role of Computed Tomography in the Classification of Pediatric Pelvic Fractures-Revisited
Melissa A Bent1, William L Hennrikus, Johan E Latorre
1*Department of Orthopaedics, Penn State Hershey Medical Center, Hershey, PA; †Pennsylvania State College of Medicine, Hershey, PA; ‡Department of Orthopaedics, Children's Hospital Colorado, Colorado Springs, CO; §Department of Pediatric Orthopaedic Surgery, Akron Children's Hospital, Akron, OH; and ‖Department of Orthopaedics, Upstate Golisano Children's Hospital, Syracuse, NY.
Insights
Plain radiographs are sufficient for most pediatric pelvic fractures, reducing unnecessary radiation exposure. Computerized tomography (CT) scans are recommended only in specific complex cases with clear clinical indications.
Area of Science:
- Pediatric Traumatology
- Radiology
- Orthopedic Surgery
Background:
- Pediatric pelvic fractures are uncommon but can result in significant morbidity.
- The role of computerized tomography (CT) in evaluating these injuries remains debated.
- Accurate assessment is crucial for appropriate management and to avoid unnecessary radiation exposure.
Purpose of the Study:
- To evaluate the necessity of CT scans in the assessment of pediatric pelvic fractures.
- To compare the diagnostic utility of plain radiographs versus CT scans in this population.
Main Methods:
- Retrospective chart review of 30 pediatric trauma patients with pelvic fractures.
- Inclusion criteria: patients with both radiograph and CT scan of the pelvis.
- Interobserver reliability assessed using Fleiss Kappa coefficient.
Main Results:
- Average patient age was 7 years; 17 males, 13 females.
- Radiograph interobserver agreement (Kappa=0.453) was similar to CT (Kappa=0.42).
- Only 10% of fractures required spica casting; none needed surgery. Four patients (11%) had associated abdominal/visceral injuries identified on CT, with varied management outcomes.
Conclusions:
- Plain radiographs are adequate for classifying and managing the majority of pediatric pelvic fractures.
- CT scans should be reserved for specific indications, including abnormal abdominal/pelvic exams, complex fractures, significant displacement, or hemodynamic instability.
- Selective use of CT can minimize radiation exposure in pediatric patients.
Objectives:
To determine the need for computerized tomography (CT) scans in the assessment of pediatric pelvic fractures.
Design:
Retrospective Chart Review.
Setting:
Level-1 Pediatric Trauma Center.
Patients/Participants:
Thirty pediatric trauma patients with pelvic fractures who have obtained both a radiograph and CT scan.
Main Outcome Measurements:
Fleiss Kappa coefficient to compare interreliability.
Results:
The average age of the patients was 7 years (range 1-13 years). Seventeen were males and 13 were females. The Torode and Zieg classification included 3 type I, 6 type II, 13 type III, and 8 type IV. The Kappa value for interobserver agreement comparing radiographs was 0.453, and for CT was 0.42. Three patients (10%) were treated with a spica cast, and none required surgery for their pelvic fracture. Four patients (11%) demonstrated liver, spleen, or kidney injuries on CT. Out of those 4, 1 had indications for laparotomy and drain placement, 1 died secondary to shock, and 2 were treated conservatively.
Conclusions:
The results of this study demonstrated that plain radiographs alone can be used to classify and manage most pediatric fractures, confirming Silber previous findings. Furthermore, we recommend the specific instances of Schreck and Haasz et al in which CT scans should be used, sparing the general pediatric population unnecessary radiation. Such cases include patients with an abnormal abdominal or pelvic examination, complex fracture patterns, displacement greater than 1 cm, femur deformities, hematuria, Glasgow Coma Scale <13, hemodynamic instability, an aspartate aminotransferase > 200 U/L, an Hct < 30%, or an abnormal chest x-ray.
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