Pelvis/Hip Case 11 Diagnosis
AP pelvis films reveal anterior pelvic injury manifesting either as widening of the pubic symphysis or vertically-oriented pubic ramus fractures. Any time there is one break in the pelvic ring, there will almost certainly be others (with the exception of isolated pubic ramus fractures from a simple fall). The posterior elements are often insufficiently visualized by plain films. The posterior ring will disrupt when the symphysis is widened by 2cm or more, even if this is not visible on the pelvis x ray. Posterior disruption can be through the sacrum or the sacroiliac joint. CT scan should be ordered to evaluate the posterior elements whenever significant pelvic injuries are diagnosed on plain films if the patient is stable enough. CT can also help diagnose pelvic hematomas and ongoing hemorrhage by noting extravasation of IV contrast.