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Disruptions of Pelvic Ring
MK Jesse, MD; Julia R. Crim, MD; Kirkland W. Davis, MD, FACR
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Tile types B & C fractures
          • Definitions

            • Partially stable fracture: posterior pelvis integrity partially maintained; rotationally unstable, vertically stable
            • Unstable fracture: complete loss of posterior pelvic integrity; rotationally & vertically unstable
            • Osseous or ligamentous disruption of pelvic ring, usually both anterior & posterior portions
              • Occasionally just anterior ring disruption [AP compression (APC) I]

          IMAGING

          • Basic Principles of Pelvic Ring

            • General Features

              • Radiographic Findings

                • CT Findings

                  • Ultrasonographic Findings

                    • Angiographic Findings

                      • Other Modality Findings

                        • Imaging Recommendations

                          • MR Findings

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Staging, Grading, & Classification

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              • Reporting Tips

                                                • Pitfall

                                                  Selected References

                                                  1. Leach SET et al: Pelvic fractures: experience of pelvic ring fractures at a major trauma centre. Clin Radiol. 74(8):649.e19-26, 2019
                                                  2. Coccolini F et al: Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 12:5, 2017
                                                  3. Khurana B et al: Pelvic ring fractures: what the orthopedic surgeon wants to know. Radiographics. 34(5):1317-33, 2014
                                                  4. Abrassart S et al: Unstable pelvic ring injury with hemodynamic instability: what seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res. 99(2):175-82, 2013
                                                  5. Gänsslen A et al: Pelvic ring injuries in children. Part I: epidemiology and primary evaluation. A review of the literature. Acta Chir Orthop Traumatol Cech. 79(6):493-8, 2012
                                                  6. Hou Z et al: Hemodynamically unstable pelvic fracture management by advanced trauma life support guidelines results in high mortality. Orthopedics. 35(3):e319-24, 2012
                                                  7. Hornez E et al: Management of exsanguinating pelvic trauma: do we still need the radiologist? J Visc Surg. 148(5):379-84, 2011
                                                  8. Starks I et al: Is a fracture of the transverse process of L5 a predictor of pelvic fracture instability? J Bone Joint Surg Br. 93(7):967-9, 2011
                                                  9. Manson T et al: Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma. 24(10):603-9, 2010
                                                  10. Papakostidis C et al: Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. Injury. 40 Suppl 4:S53-61, 2009
                                                  11. Verbeek D et al: Acute management of hemodynamically unstable pelvic trauma patients: time for a change? Multicenter review of recent practice. World J Surg. 32(8):1874-82, 2008
                                                  12. Gardner MJ et al: Stabilization of unstable pelvic fractures with supraacetabular compression external fixation. J Orthop Trauma. 21(4):269-73, 2007
                                                  13. Suzuki T et al: Long-term functional outcome after unstable pelvic ring fracture. J Trauma. 63(4):884-8, 2007
                                                  14. Durkin A et al: Contemporary management of pelvic fractures. Am J Surg. 192(2):211-23, 2006
                                                  15. Marx J et al: Rosen's Emergency Medicine: Concepts and Clinical Practice. Vol 1. 6th ed. Mosby. 717-35, 2006
                                                  16. Bucholz et al: Rockwood and Green's: Fractures In Adults. Vol 2. 6th ed. Lippincott Williams & Wilkins. 1584-1664, 2005
                                                  17. Park J et al: Imaging of pelvic trauma. Contemporary Diagnostic Radiology. 28(24):1-6, 2005
                                                  18. Demetriades D et al: Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 195(1):1-10, 2002
                                                  19. Coppola PT et al: Emergency department evaluation and treatment of pelvic fractures. Emerg Med Clin North Am. 18(1):1-27, v, 2000
                                                  Related Anatomy
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                                                  Related Differential Diagnoses
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                                                  References
                                                  Tables

                                                  Tables

                                                  KEY FACTS

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Tile types B & C fractures
                                                          • Definitions

                                                            • Partially stable fracture: posterior pelvis integrity partially maintained; rotationally unstable, vertically stable
                                                            • Unstable fracture: complete loss of posterior pelvic integrity; rotationally & vertically unstable
                                                            • Osseous or ligamentous disruption of pelvic ring, usually both anterior & posterior portions
                                                              • Occasionally just anterior ring disruption [AP compression (APC) I]

                                                          IMAGING

                                                          • Basic Principles of Pelvic Ring

                                                            • General Features

                                                              • Radiographic Findings

                                                                • CT Findings

                                                                  • Ultrasonographic Findings

                                                                    • Angiographic Findings

                                                                      • Other Modality Findings

                                                                        • Imaging Recommendations

                                                                          • MR Findings

                                                                            DIFFERENTIAL DIAGNOSIS

                                                                              PATHOLOGY

                                                                              • General Features

                                                                                • Staging, Grading, & Classification

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              • Reporting Tips

                                                                                                • Pitfall

                                                                                                  Selected References

                                                                                                  1. Leach SET et al: Pelvic fractures: experience of pelvic ring fractures at a major trauma centre. Clin Radiol. 74(8):649.e19-26, 2019
                                                                                                  2. Coccolini F et al: Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 12:5, 2017
                                                                                                  3. Khurana B et al: Pelvic ring fractures: what the orthopedic surgeon wants to know. Radiographics. 34(5):1317-33, 2014
                                                                                                  4. Abrassart S et al: Unstable pelvic ring injury with hemodynamic instability: what seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res. 99(2):175-82, 2013
                                                                                                  5. Gänsslen A et al: Pelvic ring injuries in children. Part I: epidemiology and primary evaluation. A review of the literature. Acta Chir Orthop Traumatol Cech. 79(6):493-8, 2012
                                                                                                  6. Hou Z et al: Hemodynamically unstable pelvic fracture management by advanced trauma life support guidelines results in high mortality. Orthopedics. 35(3):e319-24, 2012
                                                                                                  7. Hornez E et al: Management of exsanguinating pelvic trauma: do we still need the radiologist? J Visc Surg. 148(5):379-84, 2011
                                                                                                  8. Starks I et al: Is a fracture of the transverse process of L5 a predictor of pelvic fracture instability? J Bone Joint Surg Br. 93(7):967-9, 2011
                                                                                                  9. Manson T et al: Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma. 24(10):603-9, 2010
                                                                                                  10. Papakostidis C et al: Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. Injury. 40 Suppl 4:S53-61, 2009
                                                                                                  11. Verbeek D et al: Acute management of hemodynamically unstable pelvic trauma patients: time for a change? Multicenter review of recent practice. World J Surg. 32(8):1874-82, 2008
                                                                                                  12. Gardner MJ et al: Stabilization of unstable pelvic fractures with supraacetabular compression external fixation. J Orthop Trauma. 21(4):269-73, 2007
                                                                                                  13. Suzuki T et al: Long-term functional outcome after unstable pelvic ring fracture. J Trauma. 63(4):884-8, 2007
                                                                                                  14. Durkin A et al: Contemporary management of pelvic fractures. Am J Surg. 192(2):211-23, 2006
                                                                                                  15. Marx J et al: Rosen's Emergency Medicine: Concepts and Clinical Practice. Vol 1. 6th ed. Mosby. 717-35, 2006
                                                                                                  16. Bucholz et al: Rockwood and Green's: Fractures In Adults. Vol 2. 6th ed. Lippincott Williams & Wilkins. 1584-1664, 2005
                                                                                                  17. Park J et al: Imaging of pelvic trauma. Contemporary Diagnostic Radiology. 28(24):1-6, 2005
                                                                                                  18. Demetriades D et al: Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 195(1):1-10, 2002
                                                                                                  19. Coppola PT et al: Emergency department evaluation and treatment of pelvic fractures. Emerg Med Clin North Am. 18(1):1-27, v, 2000