Xray Skills 3:
Interpretation of a Pelvic X-ray
In the emergency management of the trauma patient, it is not necessary to extensively describe and classify pelvic fractures. It is, however, important to simply identify a pelvic fracture as being present. The reason for this is that although certain types of pelvic fractures are more dangerous than others, all pelvic fractures involving the pelvic ring are potentially life threatening. Systematically reviewing the AP view of the pelvis will pick up almost all significant fractures. This is an effective system:
Check for interruption of the arcuate and ilioishial lines including the symphysis pubis. The symphysis pubis space should be less than 1 cm wide in pregnancy and less than 0.5 cm wide in adults. PEDS: In children, this space varies with the degree of ossification of the pubic bones.
Check for widening or displacement of the sacroiliac joints. Check the transverse processes of L-5 because these may fracture with sacroiliac disruption.
Check the sacrum for evidence of fracture. The arcs of the foramina may be interrupted with sacral fractures.
Check the acetabula for interruption and femoral dislocation. Check the femoral heads and necks for interruption.
