Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures

J V Nüchtern; M J Hartel; F O Henes; M Groth; S Y Jauch; J Haegele; D Briem; M Hoffmann; W Lehmann; J M Rueger; L G Großterlinden

doi:10.1016/j.injury.2014.10.050

Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures

Injury. 2015 Feb;46(2):315-9. doi: 10.1016/j.injury.2014.10.050. Epub 2014 Oct 22.

Authors

J V Nüchtern¹, M J Hartel², F O Henes³, M Groth³, S Y Jauch⁴, J Haegele⁵, D Briem², M Hoffmann², W Lehmann², J M Rueger², L G Großterlinden²

Affiliations

¹ Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. Electronic address: j.nuechtern@uke.de.
² Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
³ Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
⁴ Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, 21079 Hamburg, Germany.
⁵ Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.

PMID: 25527459
DOI: 10.1016/j.injury.2014.10.050

Abstract

Introduction: Patients with a fracture in the anterior pelvic ring often simultaneously demonstrate pain in the posterior pelvic ring. The aim of the present prospective study was to assess the sensitivity of CT, MRI and clinical examination in the detection of fractures in the posterior pelvic ring in patients with fractures of the anterior pelvic ring diagnosed in conventional radiographs.

Methods: Sixty patients with radiographic signs of an anterior pelvic ring injury were included in this prospective analysis. Following a focused clinical examination of the posterior pelvis, all patients underwent both a CT and then a MRI scan of their pelvis. Two board certified radiologists evaluated the CT and MRI scans independently. To estimate the presence of osteoporosis the Hounsfield units of the vertebral body of L5 were measured in each case.

Results: Fifty-three women and seven men, with a mean age of 74.7+/-15.6 years were included into the study. A fracture of the posterior pelvic ring was found in fourty-eight patients (80%) patients using MRI. Fractures of the posterior pelvic ring would have been missed in eight cases (17%), if only CT had been used. Eighty-five percent of the patients with a posterior fracture had an osteoporosis. The majority of the cases suffered from a low energy trauma. Thirty-eight patients (83%) with positive clinical signs at the posterior pelvic ring actually had a fracture of the posterior pelvic ring in the MRI. The clinical examination proved to be equally effective to CT in detecting posterior pelvic ring fractures.

Conclusion: The significance of both, clinical examination and CT was confirmed in the detection of fractures in the posterior pelvic ring. MRI examination of the pelvis however, was found to be superior in detecting undislocated fractures in a cohort of patients with a high incidence of osteoporosis. Using MRI may be beneficial in select cases, especially when reduced bone density is suspected.

Keywords: CT; Clinical examination; Elderly; MRI; Osteoporosis; Pelvic ring fractures.

Publication types

Comparative Study
Evaluation Study

MeSH terms

Aged
Female
Fractures, Bone / diagnosis*
Fractures, Bone / diagnostic imaging
Fractures, Bone / pathology
Geriatric Assessment / methods*
Humans
Magnetic Resonance Imaging*
Male
Osteoporosis / complications*
Osteoporosis / diagnostic imaging
Osteoporosis / pathology
Pelvic Bones / diagnostic imaging
Pelvic Bones / injuries
Pelvic Bones / pathology*
Physical Examination*
Predictive Value of Tests
Prospective Studies
Reproducibility of Results
Sensitivity and Specificity
Tomography, X-Ray Computed*
Trauma Severity Indices