title: Advanced Imaging Lacks Clinical Utility in Treating Geriatric Pelvic Ring Injuries Caused by Low-Energy Trauma.
abstract: OBJECTIVE
  Is advanced imaging necessary in the evaluation of pelvic fractures caused by low-energy trauma in elderly patients?
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Single institution, Level 1 Trauma Center.
  
  
  METHODS
  Age ≥60 years old treated for low-energy traumatic pelvic ring injuries.
  
  
  METHODS
  None.
  
  
  RESULTS
  Posterior pelvic ring injuries diagnosed on advanced imaging, radiographic displacement, admission status, hospital length of stay, change in weight-bearing status recommendations, and whether operative treatment was pursued.
  
  
  RESULTS
  Eighty-seven patients met the inclusion criteria, of which 42 had advanced imaging to evaluate the posterior pelvic ring (10 magnetic resonance imaging, 32 computed tomography). More posterior pelvic ring injuries were identified with advanced imaging compared with radiographs alone (P < 0.001). There was no statistically significant difference in rate of admission (P = 0.5) or hospital length of stay (P = 0.31) between patients with radiographs alone compared with patients evaluated with radiographs plus advanced imaging. The rate of displacement >1 cm at presentation and 6-week follow-up was unaffected by the presence of a posterior injury diagnosed on advanced imaging. Treatment for all 87 patients remained weight-bearing as tolerated with assist device irrespective of advanced imaging findings, and no patient underwent surgical intervention by 12-week follow-up.
  
  
  CONCLUSIONS
  Despite frequent identification of posterior pelvic ring injuries in patients evaluated with advanced imaging, admission status, length of hospital stay, radiographic displacement, and treatment recommendations were unaffected by these findings. The use of advanced imaging in elderly patients with low-energy traumatic pelvic ring fractures may not be necessary.
  
  
  METHODS
  Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopedic Surgery, Shock Trauma Center, University of Maryland, Baltimore, MD; and †Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center Chicago, Maywood, IL.
authors.forename: Roman M
authors.initials: RM
authors.lastname: Natoli
authors.forename: Harold A
authors.initials: HA
authors.lastname: Fogel
authors.forename: Daniel
authors.initials: D
authors.lastname: Holt
authors.forename: Adam
authors.initials: A
authors.lastname: Schiff
authors.forename: Mitchell
authors.initials: M
authors.lastname: Bernstein
authors.forename: Hobie D
authors.initials: HD
authors.lastname: Summers
authors.forename: William
authors.initials: W
authors.lastname: Lack
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007089:Image Enhancement / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data*; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review