Abstract
BackgroundFractures of the pelvic ring in elderly patients have increased in frequency over time. These injuries are associated with a high morbidity and have a socio-economic impact. The diagnostic procedures and their influence of therapy decisions are still controversial.MethodsIn a retrospective study, we investigate the value of additional MRI examination on therapy decision of fragility fractures of the pelvis. The evaluation of all patients with pelvic fractures without adequate trauma and with performed CT and MRI was conducted at three large German hospitals. The imaging procedure took place within a maximum interval of 4 weeks. After evaluation of the imaging, the resulting therapeutic consequences either based on CT alone or on CT and MRI were reviewed by experienced pelvic surgeons.ResultsOf 754 patients with pelvic injuries, 67 (age 80 +/- 9.7 years, f: m 54:13) could be included. The detection of vertical fractures in CT (n = 40 unilateral, n = 11 bilateral) could be increased by the additional MRI (n = 44 unilateral, n = 23 bilateral). A horizontal fracture component was identified in CT in 9.0% (n = 6) vs. MRI in 25.4% (n = 17) of the cases. An anterior pelvic ring injury was detected in 71.6% (n = 44; 4x bilateral) in CT, in 80.6% in MRI (n = 50, 4 bilateral). Additive MRI imaging increased the decision rate for surgical therapy from 20.9% (n = 14) to 31.3% (n = 21).ConclusionsThe results of this study further support the value of bone marrow edema detection by MRI diagnostics (or dual source CT which showed promising initial results) for the detection of pelvic ring fractures. For the first time, the study identifies an additional therapeutic consequence by an increased rate of surgical procedures.
Highlights
Due to the demographic development of an ageing population, the number of pelvic fractures in the elderly is increasing [1,2,3]
We investigate the value of additional MRI examination on therapy decision of fragility fractures of the pelvis
A horizontal fracture component was identified in CT in 9.0% (n = 6) vs. MRI in 25.4% (n = 17) of the cases
Summary
Due to the demographic development of an ageing population, the number of pelvic fractures in the elderly is increasing [1,2,3]. Nuchtern et al described in a patient collective (n = 60) a detection rate of the posterior pelvic ring fracture in CT of 71%. Similar results were shown in the study by Henes et al (n = 38) with a detection rate of sacral fractures in CT of 66% and in MRI of 99% These studies included patients with trauma who had an anterior pelvic ring fracture in x-ray [9]. Fractures of the pelvic ring in elderly patients have increased in frequency over time These injuries are associated with a high morbidity and have a socio-economic impact.
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