Quantitative MDCT assessment of binder effects after pelvic ring disruptions using segmented pelvic haematoma volumes and multiplanar caliper measurements

  • David Dreizin
  • Uttam Bodanapally
  • Daniel Mascarenhas
  • Robert V. O’Toole
  • Nikki Tirada
  • Ghada Issa
  • Jason Nascone
Musculoskeletal
  • 49 Downloads

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusion

Rotationally unstable patients with binders have significantly less sacroiliac diastasis versus controls, corresponding with significantly lower haematoma volumes.

Key Points

• 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.

Keywords

Pelvis Pelvic bones Injuries Tomography, X-ray computed Imaging, Three-dimensional 

Abbreviations

AIS

Abbreviated injury scale

AP

Antero-posterior

APC

Antero-posterior compression

AP-PSO

Antero-posterior pubic symphysis offset

AP-SIO

Antero-posterior sacroiliac offset

CM

Combined mechanism

CT

Computed tomography

EUA

Exam under anaesthesia

ICC

Intraclass correlation coefficient

IQR

Interquartile range

ISS

Injury severity score

LC

Lateral compression

LR

Likelihood ratio

MDCT

Multidetector computed tomography

PCCD

Pelvic circumferential compression device

PSD

Pubic symphysis diastasis

OR

Odds ratio

ROC

Receiver operating characteristic

SI

Sacroiliac

SID

Sacroiliac diastasis

V-PSO

Vertical pubic symphysis offset

VS

Vertical shear

V-SIO

Vertical sacroiliac offset

Notes

Compliance with ethical standards

Guarantor

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.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• cross-sectional study

• observational

• performed at one institution

Supplementary material

330_2018_5303_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 17.3 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Trauma and Emergency Radiology, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.University of Maryland School of MedicineBaltimoreUSA
  3. 3.Orthopaedic Traumatology, Department of Orthopaedics, R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimoreUSA
  4. 4.Department of Diagnostic Radiology and Nuclear MedicineUniversity of Maryland School of MedicineBaltimoreUSA

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