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Diagnostic accuracy of pelvic radiographs for the detection of traumatic pelvic fractures in the elderly

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Abstract

Purpose

Prompt identification of traumatic pelvic fractures in the elderly is critical to guide clinical management; however, the accuracy of pelvic radiographs is often compromised by multiple factors. The purpose of this study is to examine the diagnostic accuracy of radiographs for the detection of pelvic fractures, with CT as the standard of reference.

Methods

A retrospective review was performed of patients ≥ 65 years with traumatic pelvic fractures evaluated with both pelvic radiography and computed tomography (CT) from May 2016 to October 2019. Pelvic fractures were classified into fractures of the pubis, ilium, ischium, sacrum, and acetabulum. All pelvic radiographs were independently reviewed by two emergency radiologists. Original CT reports were utilized for the reference standard.

Results

177 patients were included, with a total of 555 fractures. The mean age was 81 years and 68% were female. The most common mechanism of injury was fall (62%), followed by motor vehicle accidents (18%). The most fractured bone was the pubis (314/555 fractures). Global pooled sensitivity for pelvic radiographs in detecting pelvic fractures compared to CT was 48%, with a specificity of 93%. Sensitivity for the detection of pelvic fractures is classified by the following types: pubis 61%, acetabulum 60%, ilium 41%, sacrum 20%, and ischium 17%. Eighteen patients (10%) required surgical fixation. Mortality was 8%.

Conclusion

Pelvic radiographs have low sensitivity in detecting traumatic pelvic fractures. These radiographically occult fractures may be clinically significant as a cause of long-term pain and may require orthopedic consultation and possible surgical management.

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Authors and Affiliations

  1. Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Yuntong Ma, Jacob C. Mandell, Tatiana Rocha, Maria ADuran Mendicuti & Bharti Khurana

  2. Department of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Michael J. Weaver

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  1. Yuntong Ma
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  2. Jacob C. Mandell
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Correspondence to Bharti Khurana.

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Conflict of interest

Nonrelevant disclosures for Bharti Khurana: GE Health Care Research Funding Royalties, Section Editor Uptodate Wolters Kluwer Royalties, Cambridge University Press.

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Ma, Y., Mandell, J.C., Rocha, T. et al. Diagnostic accuracy of pelvic radiographs for the detection of traumatic pelvic fractures in the elderly. Emerg Radiol 29, 1009–1018 (2022). https://doi.org/10.1007/s10140-022-02090-w

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