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

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

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.

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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

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Trauma and Emergency Radiology, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA

    David Dreizin & Uttam Bodanapally

  2. University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA

    Daniel Mascarenhas

  3. Orthopaedic Traumatology, Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA

    Robert V. O’Toole & Jason Nascone

  4. Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA

    Nikki Tirada & Ghada Issa

Authors
  1. David Dreizin
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  2. Uttam Bodanapally
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  3. Daniel Mascarenhas
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  4. Robert V. O’Toole
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  5. Nikki Tirada
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  6. Ghada Issa
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  7. Jason Nascone
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Correspondence to David Dreizin.

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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.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• cross-sectional study

• observational

• performed at one institution

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Dreizin, D., Bodanapally, U., Mascarenhas, D. et al. Quantitative MDCT assessment of binder effects after pelvic ring disruptions using segmented pelvic haematoma volumes and multiplanar caliper measurements. Eur Radiol 28, 3953–3962 (2018). https://doi.org/10.1007/s00330-018-5303-8

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  • DOI: https://doi.org/10.1007/s00330-018-5303-8

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