Quantitative MDCT assessment of binder effects after pelvic ring disruptions using segmented pelvic haematoma volumes and multiplanar caliper measurements
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To assess effects of pelvic binders for different instability grades using quantitative multidetector computed tomography (MDCT) parameters including segmented pelvic haematoma volumes and multiplanar caliper measurements.
CT examinations of 49 patients with binders and 49 controls performed from January 2008–June 2016, and matched 1:1 for Tile instability grade and Pennal/Young-Burgess force vector, were compared for differences in pubic symphysis and sacroiliac displacement using caliper measurements in three orthogonal planes. Pelvic haematoma volumes (ml) were derived using semi-automated seeded region-growing segmentation. Median caliper measurements and volumes were compared using the Mann-Whitney U test, and correlations assessed with Pearson’s correlation coefficient. Relevant caliper measurement cutoffs were established using ROC analysis.
Rotationally unstable (Tile B) patients with binders showed significant decreases in sacroiliac diastasis (2.7 mm vs. 4.5 mm; p=0.003) and haematoma volumes (135 ml vs. 295 ml; p=0.008). Globally unstable (Tile C) binder patients showed decreased sacroiliac diastasis (4.7 mm vs. 6.4 mm, p=0.04), without significant difference in haematoma volumes (284 ml vs. 234 ml, p=0.34). Four Tile C patients with binders demonstrated over-reduction resulting in pubic body over-ride.
Rotationally unstable patients with binders have significantly less sacroiliac diastasis versus controls, corresponding with significantly lower haematoma volumes.
• Haematoma segmentation and multiplanar caliper measurements provide new insights into binder effects.
• Binder reduction corresponds with decreased pelvic haematoma volume in rotationally unstable injuries.
• Discrimination between rotational and global instability is important for management.
• Several caliper measurement cut-offs discriminate between rotationally and globally unstable injuries.
• Pubic symphysis over-ride is suggestive of binder over-reduction in globally unstable injuries.
KeywordsPelvis Pelvic bones Injuries Tomography, X-ray computed Imaging, Three-dimensional
Abbreviated injury scale
Antero-posterior pubic symphysis offset
Antero-posterior sacroiliac offset
Exam under anaesthesia
Intraclass correlation coefficient
Injury severity score
Multidetector computed tomography
Pelvic circumferential compression device
Pubic symphysis diastasis
Receiver operating characteristic
Vertical pubic symphysis offset
Vertical sacroiliac offset
Compliance with ethical standards
The scientific guarantor of this publication is David Dreizin, MD.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise.
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• case-control study
• cross-sectional study
• performed at one institution
- 4.Vermeulen B, Peter R, Hoffmeyer P, Unger P (1999) Prehospital stabilization of pelvic dislocations: a new strap belt to provide temporary hemodynamic stabilization. Swiss Surg 5Google Scholar
- 7.Surgeons ACo (2006) Advanced trauma life support for doctors, Student Course Manual, 7, ChicagoGoogle Scholar
- 18.Holstein J, Culemann U, Pohlemann T (2012) What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res® 470:2090-2097Google Scholar
- 23.Dreizin D, Bodanapally UK, Neerchal N, Tirada N, Patlas M, Herskovits E (2016) Volumetric analysis of pelvic haematomas after blunt trauma using semi-automated seeded region growing segmentation: a method validation study. Abdom Radiol. https://doi.org/10.1007/s00261-016-0822-8:1-6
- 27.Pennal GF, Tile M, Waddell JP, Garside H (1980) Pelvic disruption: assessment and classification. Clin Orthop Relat Res 151:12–21Google Scholar