Before treating pelvic disruption it is prudent to characterize the injury by its clinical and radiologic features.Clinical and Radiographic assessment of the pelvic fracture victim. Patient should be cilnically examined to look for open wounds, deformities, neurovascular assessment, and uogenital and rectal injury
Radiologic evaluation is carried out by plain xrays (anteroposterior, inlet, outlet, Judet views), computed tomography, fluoroscopy and stress views. In case of need specialized imaging like 3D CT, angiogram, magnetic resonance imaging can be done.
Pelvic region should be examined for evidence of asymmetry or instability, or the presence of an open wound. A laceration in the groin, scrotum, or perineal region of the vagina and rectum is highly suspicious of an open pelvic fracture. An apparent deformity of the lower extremity in the absence of a fracture in the lower limb may indicate a pelvic fracture.
If there is marked hemodynamic instability, limit the initial radiographic assessment of the pelvis to an AP view. Once hemodynamic and other urgent considerations permit, obtain additional radiographic views so that the injury can be precisely characterized.
At least three views are required: Anteroposterior, inlet, and outlet.
To obtain an inlet view of the supine patient, direct the x-ray beam from the head to the midpelvis at about 45 degree with respect to the radiographic table or 45 degree from the vertical reference axis.
This illustrates the true pelvic inlet as well as anteroposterior displacement of a pelvic disruption.
To obtain an outlet projection of a supine patient, direct the beam from the foot to the pubic symphysis at 45 degree with respect to the radiographic plate.
The outlet projection discloses superior displacement of the posterior half of the pelvis.
If the anteroposterior view indicates a possible acetabular disruption, supplementary Judet or oblique obturator and iliac views for acetabulum should be obtained.
Judet views can be obtained by rolling the injured patient carefully from one side to the other to provide 45 degree views.
Occult pelvic instability may be detected by anteroposterior radiographs.
Computed tomography is indispensable for documentating sites of pelvic disruption, displacement, and comminution.
Ct has a definitive role is to clarify posterior disruption of a pelvic ring fracture. A sacral fracture that can be missed on radiographs is readily seen on CT. The degree of separation and instability of a SI joint or sacral fracture is evident.
Computer programs now can produce 3D surface reformations, or so-called 3D CT images which can be helpful for surgical decisions.
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