Mapping of Pelvic Ring Injuries From High-Energy Trauma Using Unfolded CT Image Technology

Abstract

High-energy pelvic ring injuries are associated with significant morbidity and mortality, elevating the importance of injury pattern identification. The purpose of this study was to use a novel 3D computed tomography (CT) unfolding process to both evaluate high-energy pelvic ring injures and to produce injury frequency maps based on injury patterns.Methods: Patients 18-65 years of age presenting to a level 1 trauma center with pelvic ring injuries between 2016 and 2020 were identified. Of the 482 patients reviewed, 355 were excluded primarily due to having a low energy mechanism, inadequate radiographs, or an isolated fracture. Unfolded pelvic CT images were created using syngo.via CT Bone Reading software. Pelvic ring injury frequency maps were created using the unfolded pelvic CT images and a previously described mapping technique.Results: One hundred twenty-seven patients analyzed had a mean age of 32.7 years. The most common mechanisms of injury (MOI) were motor vehicle collision (30.7%) and fall from height (23.6%). The breakdown of pelvic ring injuries included LC1 = 44.1%, LC2 = 7.1%, LC3 = 14.2%, APC1 = 2.4%, APC2 = 15.0%, APC3 = 5.5%, and VS = 11.8%, with OTA/AO-61B = 74.0% and OTA/AO-61C = 26.0%. Pelvic ring mapping revealed that articular and bony injuries varied markedly between the different types of pelvic ring disruptions, both in type and location.Conclusions: Pelvic ring injury frequency maps created from unfolded CT images reflect consistent injury patterns providing distinctive information based on force vector mechanisms. Unfolded CT images allow for a novel way to visualize pelvic ring injuries which yield greater comprehension of failure patterns with implications for treatment.

Chiropractic Manipulation Causing Anterior-Posterior Compression Type Pelvic Ring Injury

“…Pelvic ring injuries are bimodal and are associated with both high- and low-energy mechanisms 1,2 . The orientation and magnitude in which a force acts on the pelvis at the time of injury often dictates the resulting injury pattern and severity 1,3,4 . Anteroposterior compression (APC) injuries involve a disruption of the pubic symphysis, often accompanied by a ligamentous posterior pelvic ring disruption of varying degree 1,3,4 .…”

“…The orientation and magnitude in which a force acts on the pelvis at the time of injury often dictates the resulting injury pattern and severity 1,3,4 . Anteroposterior compression (APC) injuries involve a disruption of the pubic symphysis, often accompanied by a ligamentous posterior pelvic ring disruption of varying degree 1,3,4 . Common mechanisms for these injuries include motorcycle collisions (saddle injuries from the gas tank), motor vehicle accidents (e.g., vehicle collision or pedestrian struck), or fall from a significant height; however, other unique mechanisms have been reported 5 .…”