Case: 72 year old nursing home resident in ICU is recovering from pneumonia. The patient fell down while participating in physical therapy at the bedside. There are some bruises noted at inner thigh near the scrotal area. You were informed that it will take a while to obtain a CT scan due to logistic issues. As a first step how the X-ray of the pelvis should be ordered?
Answer: Unfortunately, the utility of simple X-ray in a pelvic fracture is limited. The sensitivity to obtain any pathology can be increased by ordering X-ray with specific instructions to -
"project beam 40 degrees caudad for inlet views and 40 degrees cephalad for outlet views".
1. Kirby MW, Spritzer C. Radiographic detection of hip and pelvic fractures in the emergency department. AJR Am J Roentgenol 2010; 194:1054.
2. Dominguez S, Liu P, Roberts C, et al. Prevalence of traumatic hip and pelvic fractures in patients with suspected hip fracture and negative initial standard radiographs--a study of emergency department patients. Acad Emerg Med 2005; 12:366.