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The Lateral Stress Radiograph Identifies Occult Instability of Lateral Compression Pelvic Ring Injuries Without
Joshua A Parry1, Motasem Salameh2, Michael H Maher1
1Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and.
Objectives:
To determine if pelvic ring displacement on the lateral stress radiograph (LSR) correlated with displacement on examination under anesthesia (EUA).
Design:
Retrospective cohort study.
Setting:
Urban Level I trauma center.
Patients/Participants:
Twenty consecutive patients with unilateral minimally displaced LC1 injuries with complete sacral fractures.
Intervention:
An anteroposterior pelvis radiograph taken in the lateral decubitus position (LSR) was performed on awake patients before EUA in the operating room.
Main Outcome Measurements:
Correlation between ≥1 cm of pelvic ring displacement on the LSR and EUA.
Results:
The LSR demonstrated ≥1 cm of displacement in 11 of the 20 patients (55%). All of these patients had ≥1 cm of displacement on EUA and underwent surgical fixation. The remaining 9 patients with <1 cm of displacement on the LSR also had <1 cm of displacement on EUA and were managed nonoperatively.
Conclusions:
The LSR reliably identified occult instability in LC1 pelvic ring injuries and demonstrated 100% correlation with EUA. In contrast to EUA, the LSR does not require sedation and normalizes the amount of force applied to determine instability.
Level Of Evidence:
Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
