Z Orthop Unfall
DOI: 10.1055/a-0965-7686
Original Article/Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Magnetic Resonance Imaging in Pelvic Fractures – Part 2: Gaining Information and Clinical Therapeutic Relevance

Article in several languages: English | deutsch
Carsten Hackenbroch
1  Department of Radiology and Neuroradiology, Ulm Army Hospital
,
Charlotte Merz
2  Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sports Traumatology, Ulm Army Hospital
,
Hans-Georg Palm
2  Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sports Traumatology, Ulm Army Hospital
,
Benedikt Friemert
2  Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sports Traumatology, Ulm Army Hospital
,
Fabian Stuby
3  Casualty Hospital, Occupational Accident Casualty Hospital, Murnau
,
Patricia Lang
2  Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sports Traumatology, Ulm Army Hospital
,
AG Becken III der DGU®› Author Affiliations
Further Information

Publication History

Publication Date:
25 September 2019 (eFirst)

Abstract

Background Magnetic resonance and computed tomography (MRI, CT) has been known to compare the sensitivity for the detection of pelvic fractures with others. It is unclear whether MRI imaging beyond CT leads to therapy change. The aim of our study is to determine the information gained from MRI in the diagnosis of pelvic fractures and to reduce the effects on the form of therapy.

Patients and Methods In a retrospective, clinical study, 31 patients with pelvic fracture and CT and MRI imaging (median 81 ± 20 years, 22 female and 9 male) were examined. There was a classification according to AO classification for adequate or FFP classification for inadequate fractures. In addition, vascular, muscular, haematomatous and organic concomitant injuries as well as bone marrow edema and additional secondary findings requiring evaluation were evaluated. The type of therapy (conservative vs. surgical) and a possible type of therapy change were documented for each patient. Exact test according to Fisher was tested orienting.

Results Overall, MRI showed a greater fracture rate of pelvic fractures in 29% (n = 9) patients than CT. Four type I fractures according to FFP classification were identified as type II fractures and 4 type II fractures as type IV fractures. One type B1 fracture according to AO classification was found to be C2 fracture on MRI. Fisherʼs Exact Test found that the parameters “adequacy of trauma” and “fracture type change” by MRI were p = 0.38. MRI showed a total of 82 concomitant injuries, CT 31. Overall, MRI gained information in 75% (n = 24) of all patients examined. A change from conservative to operative after MRI took place in 2 patients. No patient was surgically changed from planned surgery to conservative. The extent to which MRI caused changes within one form of therapy (conservative, operative) could not be determined retrospectively. In 18% of patients with an inadequate fracture, however, according to the literature, the treatment regimen would have changed pro forma.

Conclusion In summary, it can be stated that the MRI in our study provided an information gain in the case of adequate and inadequate pelvic fractures as well as their accompanying injuries and that a possible therapeutic relevance of this information gain could be obtained specially at the inadequate fractures showed.