CT detection of serious internal and skeletal injuries in patients with pelvic fractures

RATIONALE AND OBJECTIVES: The purpose of this study was to determine the percentage of patients with known pelvic fractures who have additional findings of intraabdominal injury, as diagnosed at abdominal computed tomography (CT), and to determine if patients with specific types or patterns of fractures are more likely to have additional injuries. MATERIALS AND METHODS: The authors reviewed the medical records of 200 consecutive patients (125 women, 75 men; age range, 4-86 years) who had been admitted to a level 1 trauma center with osseous pelvic injury secondary to blunt trauma and who had undergone abdominal CT examinations. Abdominal CT findings in these patients were classified as negative, positive, or minimal and correlated with mechanism of pelvic fracture. RESULTS: Sixty-five (32%) of the 200 patients had negative CT findings, 43 (22%) had findings attributable to the trauma but required no follow-up, and 92 (46%) had positive findings that required nonsurgical management or exploratory laparotomy. Additional pelvic fractures were identified in 63 (32%) patients. The highest prevalence of additional injuries was in patients with Malgaigne fractures (four of 15, 27%) or bilateral pubic rami fractures (six of 18, 33%). CONCLUSION: CT examinations revealed that 135 (68%) of 200 patients with pelvic fractures secondary to blunt trauma had concomitant internal or skeletal injuries and that 92 (46%) patients had injuries severe enough to require nonsurgical management or exploratory laparotomy. Patients with bilateral pubic rami fractures or Malgaigne fractures were particularly prone to additional injuries; therefore, abdominal CT examinations are recommended in these patients.