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The Utility of Obtaining Postmobilization Imaging in Nonsurgical Pelvic Ring Injuries

Winston, Benjamin A. MD; Sarker, Minhazur BS; Putnam, David MD; Gehling, Paxton BM; Eagleton, Connor BS; Friess, Darin MD

Journal of the American Academy of Orthopaedic Surgeons: September 11, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.5435/JAAOS-D-18-00254
Research Article: PDF Only

Introduction: Pelvic fractures are diverse injuries with varying degrees of severity. Treatment recommendations are determined by the associated instability. For likely stable patterns, postmobilization imaging is used to assess for occult instability. This study assesses the utility of postmobilization images and determines how often they alter the recommendations for treatment.

Methods: Records at a single level 1 trauma center from January 2007 through December 2014 were reviewed, and patients with Current Procedural Terminology codes and International Classification of Diseases, Ninth Revision codes for pelvic and acetabular fractures were identified. For those chosen for nonsurgical treatment at presentation, a detailed chart review was performed to identify patients who had postmobilization radiographs and to determine whether this imaging led to a change in treatment recommendations.

Results: Inclusion criteria were met by 762 patients whose average age was 50 years. Of 331 patients planned for nonsurgical treatment at presentation, 168 (51%) had postmobilization images. The postmobilization radiographs did not alter treatment recommendations in any of these patients; however, three of these patients underwent surgical stabilization based on the patients' report of pain with attempted mobilization.

Discussion: Routine postmobilization imaging has limited value for patients with pelvic injuries and a low likelihood for instability, such as those with incomplete sacral fractures. Eliminating this step would reduce cost and decrease radiation exposure. The need for change in treatment plan or further imaging should be based on the patient's clinical progress with weight bearing.

Level of Evidence: Level 4

From the Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR.

Correspondence to Dr. Winston:

© 2019 by American Academy of Orthopaedic Surgeons
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