Computer and magnetic resonance imaging for pelvic fractures in children

Abstract

Introduction. Fractures of pelvic bones in children are rare and make up from 0.3 to 4% of all childhood trauma, 20% of children with polytrauma have pelvic ring injuries. Comparative studies of diagnostic capabilities of MRI and CT in sacral and acetabular fractures showed that about 37% of CT were missed, therefore the authors recommended MRI as the best method in visualizing pelvic fractures.Aim of this study is to show the capabilities of CT and MRI to improve recognition of pelvic fractures.Material and methods. In the period 2010–2019, 790 children with pelvic fractures as part of polytrauma were studied. The age of children was from 8.5 to 17 years, average 10.14 ± 1.4. Computed tomography with three-phase contrast was performed in all 790 patients on Brilliance 16 scanners. MRI was performed (n = 63) on a 3 T tomograph with obtaining multiplanar STIR, T1-, T2- and PD weighted images (VI) with signal suppression factor of adipose tissue, as well as 3D isotropic images.Results. On the polytrauma severity scale (ISS), the assessment of the condition of 790 children ranged from 23.54 to 27.5 (mean 25.77) points. The main mechanism of pelvic injury was road traffic accidents (pedestrian + passenger – 63.54% (n = 502), catatrauma was in second place – 32.66% (n = 258), followed by compression – 2.15% (n = 17) , sports injury – 0.38% (n = 3), other injury – 3.43% (n = 27). 73.26% (n = 578) had multiple pelvic fractures, 20.5% (n = 162) – complicated, – 22.3% (n = 176) unstable In 63 patients with damage to the anterior pelvic ring, according to CT, MRI revealed fractures of the posterior pelvic ring in 79.36% (n = 50).Conclusion. Children with polytrauma must undergo computed tomography to exclude not only all non-muscular-skeletal injuries, but also combined pelvic fractures. We believe that for the detection and assessment of bone fractures and concomitant injuries of other tissues and organs of the pelvis, in most cases, multiphase CT with intravenous contrast is a sufficient method. MRI is important for evaluating pelvic soft tissue structures such as tendons, ligaments, nerves and fascia, as well as detecting hidden / fine bone lesions.