High-Energy Pelvic Ring Injuries: A Comprehensive Imaging Review

The pelvic ring is a closed, ring-shaped skeletal framework composed of the sacrum and paired innominate bones, stabilized by strong ligaments. It plays a critical role in weight transmission and provides protective enclosure for vital internal organs. Injuries of the pelvic ring represent a broad spectrum of injury severity, ranging from stable fractures to life-threatening unstable fracture-dislocations. Disruption of this ring can injure major vascular, neural, and genitourinary structures, with hemorrhage remaining a leading cause of preventable mortality in pelvic trauma. Although advances in resuscitation strategies, surgical techniques, and implant design have improved outcomes in pelvic ring injuries, early and accurate injury characterization remains critical to guiding appropriate management and reducing complications. CT is the cornerstone of pelvic trauma assessment and offers high-resolution visualization of fracture morphology and associated soft-tissue injuries. Radiologic imaging-based classification systems provide a structured framework for assessing fracture stability, guiding treatment decisions, and facilitating multidisciplinary management. Incorporating a systematic, checklist-driven approach to CT interpretation improves diagnostic accuracy, reduces the risk of missed injuries, and enables consistent recognition of unstable fracture patterns. The authors outline a comprehensive, structured approach for CT assessment of pelvic ring trauma, with the goal of enhancing diagnostic confidence, streamlining triage, and improving patient outcomes. ^©RSNA, 2025.