Inlet views are obtained with the patient supine and the x-ray tube positioned at the patient’s head, angled 45 degrees toward the patient’s feet. These include oblique (Judet) views for characterization of acetabular fractures ( Figure 13-2 ), and inlet and outlet views for characterization of pelvic ring fractures ( Figure 13-3 ). Additional plain films can be obtained when injuries are seen on the AP image or if occult injuries are suspected with a normal AP view. This image is obtained with the patient supine and the x-ray beam oriented 90 degrees to the patient’s long axis, passing through the patient from anterior to posterior. The routine initial view of the pelvis is the anterior–posterior (AP) x-ray ( Figure 13-1 ). Pelvic X-ray and Computed Tomography Techniques Angiography (discussed in detail in Chapter 16 ) was performed in 4.7% of patients with pelvic injuries, and therapeutic embolization was performed in 2.3%, or half of those undergoing angiography. Overall, 16.6% of pelvic fracture patients required more than 2 L of blood in transfusion. When severe pelvic injury was the only significant injury, more than 50% received transfusion, with a mean of 2.7 L. In severe pelvic fracture patients, 60.6% received transfusion, with a mean of more than 3.5 L. In one study, 38.5% of pelvic fracture patients received blood transfusion, with a mean transfusion of nearly 1 L. This low mortality is achieved when patients are treated at major trauma centers and receive aggressive therapy for pelvic injuries, including blood transfusion, orthopedic fixation, and angiographic embolization of pelvic vascular injuries. The low mortality directly attributed to pelvic injuries should not suggest that these injuries themselves are unimportant. When pelvic injuries are noted on imaging studies, careful attention should be given to determining the presence of other injuries. These are high-energy injuries that frequently coexist with severe injuries to the head, chest, abdomen, spine, and extremities. However, only about 0.8% of deaths are directly attributed to pelvic injuries.

Mortality in patients with pelvic fractures is high-13.5% in adults in one large study. Aortic rupture was seven times more common in patients with pelvic fracture than in those without, although still rare (1.4%, compared with 0.2%). In severe pelvic fractures (defined by an Abbreviated Injury Scale score ≥4), intrabdominal injuries rose in frequency to 30.7% of patients, and the bladder and urethra were most commonly injured, in 14.6% of patients. In patients with pelvic fractures, 16.5% had associated abdominal injuries, including liver (6.1%), bladder and urethra (5.8%), spleen (5.2%), diaphragm (2.1%), and small bowel (2%). How Common Are Pelvic Injuries? What Injuries Are Associated With Pelvic Trauma?Īn 8-year retrospective review of the trauma registry at the Los Angeles County and University of Southern California trauma center found that 9.3% of 16,630 adult admissions sustained some type of pelvic fracture. What is the role of interventional radiology and angiographic embolization? What special imaging tests should be considered for pelvic fractures? What associated injuries must be suspected and evaluated when pelvic fractures are detected? If CT is used in the setting of major trauma, why is MRI called upon for minor mechanisms of injury? Why is MRI recommended for some injuries and CT for others? If CT is planned for evaluation of other abdominal and pelvic soft-tissue injuries, is x-ray needed? If so, in which patients? When pelvic x-ray is normal, who needs CT? How should x-ray and CT of the pelvis be interpreted? What are the techniques for pelvic x-ray and CT? What injuries are associated with pelvic trauma? Along the way, we consider a number of critical clinical questions: Because fractures of the proximal femur are often clinically indistinguishable from fractures of the pelvis, we illustrate these injuries here, with more discussion in the chapters on extremity injuries ( Chapter 14 ) and musculoskeletal magnetic resonance imaging (MRI, Chapter 15 ). We also discuss high-risk pelvic bony injuries associated with soft-tissue and vascular injuries-which are examined in detail in related chapters on genitourinary imaging ( Chapter 12 ), abdominal trauma ( Chapter 10 ), and interventional radiology ( Chapter 16 ). In this chapter, we review a systematic approach to interpretation of the standard pelvis x-ray, correlating abnormalities with computed tomography (CT) findings. Imaging of the pelvis can be required following minor or major trauma and for nontraumatic painful conditions.

Xray normal hip lat