Subscribe to RSS
The role of computed tomography in the classification and management of pelvic fractures
Received:06 April 2008
Accepted:22 March 2008
17 December 2017 (online)
Computed tomography (CT) imaging is an important component in the pre-operative assessment of pelvic fractures in humans. The value of CT images in the management of small animal pelvic fractures is presently undetermined. The objective of this study was to investigate the benefits of CT images on the management of pelvic fractures. A prospective study of 25 traumatised cases of canine and feline pelvic fractures were evaluated, where CT images and conventional orthogonal radiographic assessments were performed on each case. Three diplomat orthopaedic surgeons independently reviewed the radio-graphs and CT images on separate occasions and determined fracture classification, management plan, estimated recovery time and prognosis. A consensus review of the imaging modalities and surgical reports was used as the definitive fracture description. For all observers, management was not found to differ significantly between radiographic and CT analysis (P< 0.05). There was moderate agreement between observers and between imaging modalities for fracture description. Greatest discrepancy was found as the fracture complexity increased, such as with acetabula and sacral fractures, whereby CT was the most sensitive. Clinically high quality radiography would be recommended for all pelvic fracture cases; CT may be beneficial where there is uncertainty, particularly with acetabula fractures or sacral fractures causing neurological deficits. Experienced orthopaedic surgeons often disagreed on the diagnosis, treatment and prognosis of pelvic trauma.
- 1 DeCamp CE. Principles of pelvic fracture management. Semin Vet Med Surg (Small Anim) 1992; 7: 63-70.
- 2 Giannoudis PV, Grotz MR, Tzioupis C. et al. Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective. J Trauma 2007; 63: 875-883.
- 3 Lanz I O. Lumbosacral and pelvic injuries. The veterinary clinics of North America small animal practice 2002; 32: 949-962.
- 4 Bookbinder PE, Flanders JA. Characteristics of pelvic fracture in the cat. A 10 year retrospective study. Vet Comp Orthop Traumatol 1992; 5: 122-127.
- 5 Falchi M, Rollandi GA. CT of pelvic fractures. Eur J Radiol 2004; 50: 96-105.
- 6 Chmelova J, Mrazkova D, Dzupa V. et al. [The role of plain radiography in pelvic trauma in the era of advanced computed tomography]. Acta Chir Orthop Traumatol Cech 2006; 73: 394-399.
- 7 Their ME, Bensch FV, Koskinen SK. et al. Diagnostic value of pelvic radiography in the initial trauma series in blunt trauma. Eur Radiol 2005; 15: 1533-1537.
- 8 Harley JD, Mack LA, Winquist RA. CT of acetabular fractures: comparison with conventional radiography. AJR Am J Roentgenol 1982; 138: 413-417.
- 9 Moores AL, Moores AP, Brodbelt DC. et al. Regional load bearing of the canine acetabulum. J Biomech 2007; 40: 3732-3737.
- 10 Beck AL, Pead MJ, Draper E. Regional load bearing of the feline acetabulum. J Biomech 2005; 38: 427-432.
- 11 Borrelli Jr J, Goldfarb C, Catalano L. et al. Assessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs. J Orthop Trauma 2002; 16: 449-456 discussion 56–57.
- 12 Aron DN PR, Johnson AL. Biologic strategies and a balanced concept for repair of highly comminuted long bone fractures. Compendium of Continuing Education for Practising Veterinarians 1995; 17: 35.
- 13 Fossum TW HCS, Johnson AL, Schulz KS. et al. Small Animal Surgery. 3rd ed. Missouri: Mosby Elsevier; 2007
- 14 Messmer M, Montavon PM. Pelvic fractures in the dog and cat: a classification system and review of 556 cases. Vet Comp Orthop Traumatol 2004; 17: 167-183.
- 15 Anderson A, Coughlan AR. Sacral fractures in dogs and cats: a classification scheme and review of 51 cases. J Small Anim Pract 1997; 38: 404-409.
- 16 Agresti A. An introduction to categorical data analysis. New York: Wiley; 1996
- 17 Yugueros P, Sarmiento JM, Garcia AF. et al. Unnecessary use of pelvic x-ray in blunt trauma. J Trauma 1995; 39: 722-725.
- 18 Guillamondegui OD, Mahboubi S, Stafford PW. et al. The utility of the pelvic radiograph in the assessment of pediatric pelvic fractures. J Trauma 2003; 55: 236-239 discussion 9–40.
- 19 Silber JS, Flynn JM, Katz MA. et al. Role of computed tomography in the classification and management of pediatric pelvic fractures. J Pediatr Orthop 2001; 21: 148-151.
- 20 Crawford JT, Manley PA, Adams WM. Comparison of computed tomography, tangential view radiography, and conventional radiography in evaluation of canine pelvic trauma. Vet Radiol Ultra-sound 2003; 44: 619-628.
- 21 Resnik CS, Stackhouse DJ, Shanmuganathan K. et al. Diagnosis of pelvic fractures in patients with acute pelvic trauma: efficacy of plain radiographs. Am J Roentgenol 1992; 158: 109-112.
- 22 Innes J, Butterworth S. Decision making in the treatment of pelvic fractures in small animals. In Practice 1996; 18: 215-221.
- 23 McCartney WT, Garvan CB. Repair of acetabular fractures in 20 dogs using a dorsal muscle separation approach. Vet Rec 2007; 160: 842-844.
- 24 Rafii M, Firooznia H, Golimbu C. et al. The impact of CT in clinical management of pelvic and acetabular fractures. Clin Orthop Relat Res 1983; 178: 228-235.
- 25 Dunbar AD. Evaluating pelvic fractures: indications for surgical correction. Vet Med Small Anim Clin 1984; 79: 1047-1052.
- 26 Montana MA, Richardson ML, Kilcoyne RF. et al. CT of sacral injury. Radiology 1986; 161: 499-503.
- 27 Vas WG, Wolverson MK, Sundaram M. et al. The role of computed tomography in pelvic fractures. J Comput Assist Tomogr 1982; 6: 796-801.
- 28 Adam P, Labbe JL, Alberge Y. et al. The role of computed tomography in the assessment and treatment of acetabular fractures. Clin Radiol 1985; 36: 13-18.
- 29 Gill K, Bucholz RW. The role of computerized tomographic scanning in the evaluation of major pelvic fractures. J Bone Joint Surg Am 1984; 66: 34-39.
- 30 Hoffmeyer P, Seigne JM, Garcia J. et al. The value of computerized tomography in fractures of the pelvic ring. Int Orthop 1984; 8: 1-8.
- 31 Albrecht T, von Schlippenbach J, Stahel PF. et al. [The role of whole body spiral CT in the primary work-up of polytrauma patients – comparison with conventional radiography and abdominal sonography]. Rofo 2004; 176: 1142-1150.
- 32 Kuntz CA, Waldron D, Martin RA. et al. Sacral fractures in dogs: a review of 32 cases. J Am Anim Hosp Assoc 1995; 31: 142-150.
- 33 Bottini A, Seljeskog EL. Fractures of the sacrum. In: Doty JR, Rangachary SS, editor. Surgical disorders of the sacrum. New York: Thieme Medical Publishers; 1994: 133-142.
- 34 White JH, Hague C, Nicolaou S. et al. Imaging of Sacral Fractures. Clinical Radiology 2003; 58: 914-921.