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Disoriented, Intoxicated, and Hurting All Over
Answer
The radiograph demonstrates a mildly displaced fracture of the right iliac wing. In addition, there is moderate diastasis of the pubic symphysis, with the right pubic symphysis being in superior position to the left. Also, a right sacral fracture is present.
The patient was admitted by the trauma service and initially evaluated by the orthopedic trauma team, who planned to take the patient to surgery for subsequent open reduction and internal fixation of these injuries.
Answer
The radiograph demonstrates a mildly displaced fracture of the right iliac wing. In addition, there is moderate diastasis of the pubic symphysis, with the right pubic symphysis being in superior position to the left. Also, a right sacral fracture is present.
The patient was admitted by the trauma service and initially evaluated by the orthopedic trauma team, who planned to take the patient to surgery for subsequent open reduction and internal fixation of these injuries.
Answer
The radiograph demonstrates a mildly displaced fracture of the right iliac wing. In addition, there is moderate diastasis of the pubic symphysis, with the right pubic symphysis being in superior position to the left. Also, a right sacral fracture is present.
The patient was admitted by the trauma service and initially evaluated by the orthopedic trauma team, who planned to take the patient to surgery for subsequent open reduction and internal fixation of these injuries.
A woman, approximately 30 years old, is airlifted to your facility after being “found in a ditch,” presumably as a result of a motor vehicle collision. Details are sketchy. Upon arrival at your facility, she is awake, crying, and complaining of “hurting all over.” She appears to be intoxicated. She is able to give you her name, but not much else in the way of history. Primary survey shows her vital signs to be: blood pressure, 105/75 mm Hg; heart rate, 102 beats/min; and respiratory rate, 20 breaths/min. She is afebrile. She has a superficial scalp laceration but no other obvious injuries. You obtain preliminary portable radiographs of the pelvis. What is your impression?
Unrestrained Passenger Injured in Car Accident
ANSWER
There is a cortical irregularity at the medial margin of the left iliac bone at the level of the acetabulum, strongly suggestive of a fracture. In addition, there may be a nondisplaced fracture within the superior/inferior rami on the left.
CT was recommended to further define these areas (and was already pending to evaluate the patient’s abdomen). Fortunately, there were no fractures within the hip joint, just the nondisplaced rami fracture.
ANSWER
There is a cortical irregularity at the medial margin of the left iliac bone at the level of the acetabulum, strongly suggestive of a fracture. In addition, there may be a nondisplaced fracture within the superior/inferior rami on the left.
CT was recommended to further define these areas (and was already pending to evaluate the patient’s abdomen). Fortunately, there were no fractures within the hip joint, just the nondisplaced rami fracture.
ANSWER
There is a cortical irregularity at the medial margin of the left iliac bone at the level of the acetabulum, strongly suggestive of a fracture. In addition, there may be a nondisplaced fracture within the superior/inferior rami on the left.
CT was recommended to further define these areas (and was already pending to evaluate the patient’s abdomen). Fortunately, there were no fractures within the hip joint, just the nondisplaced rami fracture.
A 19-year-old man is transferred to your facility for injuries he sustained in a motor vehicle collision. He was an unrestrained passenger in a vehicle that went out of control and left the road. At the outside facility, he was found to have a chest injury and a pneumothorax, resulting in his transfer for tertiary level care. On arrival, he is complaining of some chest wall pain, but also states that his hips—especially the left one—are causing quite a bit of discomfort. His medical history is unremarkable except for sickle cell trait. Primary survey reveals stable vital signs and no obvious injury. On closer examination, with stress on his pelvis, he does complain of localized pain on the left side. Radiograph of the pelvis is obtained. What is your impression?
