Can MDCT Unmask Instability in Binder-Stabilized Pelvic Ring Disruptions?
OBJECTIVE
Pelvic binders may hinder radiologic assessment of pelvic instability after trauma, and avulsive injuries can potentially unmask instability in this setting. We compare the performance of MDCT for the detection of pelvic disruptions in patients with binders to a matched cohort without binders, and we assess the utility of avulsive injuries as signs of pelvic instability.


METHODS
MDCT examinations of 56 patients with binders were compared with MDCT examinations of 54 patients without binders. Tile grading by an experienced orthopedic surgeon was used as the reference standard (A, stable; B, rotationally unstable; C, rotationally and vertically unstable). Two radiologists performed blinded reviews of CT studies in two reading sessions (sessions 1 and 2). In session 1, Tile grade was predicted on the basis of established signs of instability, including pubic symphysis and sacroiliac (SI) joint widening. In session 2, readers could change the Tile grade when avulsive injuries were seen. Diagnostic performance for predicting rotational instability and vertical instability was assessed.


RESULTS
In the binder group, AUCs under the ROC curves for rotational instability increased from fair (0.73-0.77) to good (0.82-0.89) when avulsive signs were considered. In the control group, AUCs were good in both sessions. AUCs for vertical instability were fair with binders in both sessions. Agreement with the reference standard increased from fair (0.30-0.32) to moderate (0.46-0.54) when avulsive signs were considered in the binder group but were in the moderate range for both sessions in the control group. Combined evaluation for inferolateral sacral fractures, ischial spine fractures, and rectus abdominis avulsions resulted in optimal discrimination of rotational instability.


CONCLUSIONS
Evaluation for avulsive signs improves MDCT sensitivity for the detection of rotational instability but not vertical instability in patients with binders.
1 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201.
David
D
Dreizin
2 Department of Orthopedics, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, Baltimore, MD.
Jason
J
Nascone
1 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201.
Derik L
DL
Davis
1 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201.
Daniel
D
Mascarenhas
1 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201.
Nikki
N
Tirada
1 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201.
Haoxing
H
Chen
1 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201.
Uttam K
UK
Bodanapally
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D058128:Compression Bandages; D005260:Female; D000071562:Fractures, Avulsion / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D007103:Immobilization / Q000295:instrumentation / Q000379:methods; D004204:Joint Dislocations / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult
Tile classification; pelvic binder; pelvic orthotic device; pelvic ring disruptions; pelvic trauma