The role of computerized tomographic scanning in the evaluation of major pelvic fractures

Twenty-five patients with double vertical fractures of the pelvic ring had evaluations by both plain radiography and computed-tomography scanning of the pelvic. In eight of the twenty-five patients, the interpretation that was made from the plain radiographs, based on the classification of Pennal et al., changed when additional anatomical information was provided by the computed-tomography scan. We recommend that computed tomography be used for: (1) double vertical fracture-dislocations of the pelvic ring in which plain radiographs are inadequate to judge pelvic stability, (2) fractures of the pelvic ring with extension into the acetabulum, and (3) major injuries to the hemipelvis that are to be treated by open reduction and internal fixation. However, due to the increased cost and radiation exposure, routine computed-tomography scanning is not justified for all injuries to the pelvic ring.