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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.

Journal of Orthopaedic Trauma
|October 16, 2020
PubMed
Summary

The lateral stress radiograph (LSR) accurately identifies pelvic ring instability in LC1 injuries, correlating perfectly with examination under anesthesia (EUA) findings without sedation.

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Area of Science:

  • Orthopedic surgery
  • Radiology
  • Trauma care

Background:

  • Pelvic ring injuries, particularly LC1 fractures, can present with occult instability.
  • Accurate assessment of pelvic ring displacement is crucial for treatment decisions.
  • Examination under anesthesia (EUA) is a common method to assess instability, but requires sedation.

Purpose of the Study:

  • To evaluate the correlation between pelvic ring displacement measured on a lateral stress radiograph (LSR) and displacement assessed during examination under anesthesia (EUA).
  • To determine if LSR can reliably detect instability in minimally displaced LC1 pelvic ring injuries.

Main Methods:

  • A retrospective cohort study was conducted at a Level I trauma center.
  • Twenty patients with unilateral minimally displaced LC1 injuries and sacral fractures were included.
  • Anteroposterior pelvis radiographs in the lateral decubitus position (LSR) were obtained before EUA.

Main Results:

  • The LSR demonstrated ≥1 cm of displacement in 11 of 20 patients (55%).
  • All patients with ≥1 cm displacement on LSR also had ≥1 cm displacement on EUA and required surgical fixation.
  • Patients with <1 cm displacement on LSR had <1 cm displacement on EUA and were managed nonoperatively.

Conclusions:

  • The lateral stress radiograph (LSR) is a reliable diagnostic tool for identifying occult instability in LC1 pelvic ring injuries.
  • LSR demonstrated 100% correlation with examination under anesthesia (EUA) findings.
  • LSR offers an advantage over EUA as it does not require sedation and standardizes applied force.