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General Orthopaedics

RADIOLOGICAL ASSESSMENT OF PELVIC AND ACETABULAR TRAUMA: ARE LOCAL PROTOCOLS BEING FOLLOWED?

The South West Orthopaedic Club (SWOC) Spring Meeting



Abstract

Introduction

Pelvic and acetabular injuries are relatively rare and surgical reconstruction usually occurs only in specialist centres. As part of their work up there is a local protocol for radiological investigations including Judet oblique views for acetabular fractures, pelvic inlet and outlet for pelvic ring fractures and urethrograms for sustaining anterior pelvic injury. The aim of this service evaluation was to assess whether patients had these radiological investigations prior to transfer.

Methods

The last 50 patients transferred for surgery were evaluated (41 male, 9 female), average age 48 (range 17–86). Four were excluded as original radiology not available and one due to non-acute presentation. Regional PACS systems were accessed and radiological investigations recorded.

Results

Transfers were from 17 different hospitals including 27 acetabular fractures, 17 pelvic ring fractures and one patient with both. 22 patients sustained isolated injuries. 16 patients were investigated radiologically asstipulated in the protocol. No inlet/outlet views were performed for 10 of the ring fractures, and no Judet views for eight of the acetabular fractures. An antero-posterior pelvic radiograph was not performed on one patient. No urethro/cystogram was performed for 10 pelvic ring fractures. Average time to transfer 5.4 days (range 0–22).

Discussion

A significant proportion of patients are not assessed as per protocol prior to transfer. This can lead to undetected injuries, delays to diagnosis or definitive management and increased morbidity/mortality. The reasons for not being able to perform these investigations need to be understood.