Pelvis/Hip Case 12 Diagnosis
AP pelvis films reveal anterior pelvic injury typically manifesting either as widening of the pubic symphysis or vertically-oriented pubic ramus fractures, possibly displaced cephalad. 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. Posterior disruption can be through the sacrum or the sacroiliac joint, and also may have cephalad displacement. 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.