Hip Pelvis.  2016 Mar;28(1):49-53. 10.5371/hp.2016.28.1.49.

Underestimated Sacroiliac Joint Lesion on Computed Tomography in Pelvic Open-book Injury: A Case Report

• Kim WY
• Jeong JJ
• Kang HV
• Lee SW

• KMID: 2161315
• DOI: http://doi.org/10.5371/hp.2016.28.1.49

Abstract

The classification of anteroposterior compression (APC) injury type is based on using static radiographs, stress radiographs are known as a useful adjunct in classifying type of APC pelvic injuries. According to a recent article, the intraoperative stress examination has led to a change in the treatment plan in more than 25% of patients on 22 patients presumed APC type I (symphyseal diastasis <2.5 cm) injuries. Here authors present a case demonstrating a necessity of intraoperative stress test for excluding concealed posterior ring disruption.

Keyword

Pelvic bones; Pubic symphysis diastasis; Sacroiliac joint; Fractures; Cartilage

MeSH Terms

Cartilage
Classification
Exercise Test
Humans
Pelvic Bones
Pubic Symphysis Diastasis
Sacroiliac Joint*

Figure

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  Fig. 1 Preoperative radiograph images showed 3.0-cm diastasis of pubic symphysis; pelvis anteroposterior (A), inlet (B), outlet view (C). Axial images (D, E) and three-dimensional image (F) of computed tomography (CT) revealed no diastasis of sacroiliac joint. Even if no pelvic manipulation has occurred, a static imaging like CT may lead to undersestimation of the actual injury.

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  Fig. 2 After plating of pubic symphysis, right sacroiliac joint diastasis was observed; pelvis anteroposterior (A), inlet (B), outlet view (C). (D) Coronal computed tomography (CT) image of reduced pubic symphysis. (E) Axial and (F) coronal CT images of diastasis of right sacroiliac joint.

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  Fig. 3 After supplementary sacroiliac fixation, right sacroiliac joint diastasis was reduced; pelvis anteroposterior (A), inlet (B), outlet view (C). (D, E) Axial computed tomography (CT) images of reduced pubic symphysis. (F) Coronal CT image of diastasis of right sacroiliac joint.

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  Fig. 4 One year after injury follow-up radiographs; pelvis anteroposterior (A), inlet (B), outlet view (C). It showed no screw breakage, fixation failure or heterotopic ossification.

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