General Considerations for the Pelvis and Hips
- The pelvis and hips constitute one of the most diagnostically challenging areas of the body for two main
reasons. First, it is the single area of the body where obtaining a lateral projection provides little
additional information. Second, soft tissue injuries are difficult to assess with radiographs of the pelvis,
but have greater clinical significance than in other areas of the body.
- Severe pelvic trauma is associated with hemorrhage in approximately 60% of cases. Hemorrhage is a principle
factor leading to death in this patient population.
- Systematically examine all bony structures of the pelvis and femurs for symmetry, cortical breaks and joint
spaces (sacroiliac, hip and symphysis pubis joints). Also carefully examine the common injury regions such as
the femoral neck, iliac spine, acetabulum, inferior ramus of the ischium and superior pubic ramus.
- Avulsion injuries are common and can be easily missed. Examine the frequent sites of avulsion, which are the
anterior superior iliac spine, anterior inferior iliac spine and ischial tuberosity.
- Remember that the pelvis is a ring and it is commonly broken in two or more places. The pelvic ring must remain
intact for the fracture(s) to be considered stable. If the ring is compromised, it is an unstable pelvic fracture.
- Significant pelvic ring disruption (PRD) leads to rupture of the bladder or urethral injury in approximately
20% of cases. Evaluation of the urethra with retrograde uretrogram should be performed in all male patients with
PRD prior to Foley catheter placement.
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