Radiology Review

Diagnosis Is an Open Book

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Pelvis radiograph

A 50-year-old woman is airlifted to your facility from the scene of an accident. She was riding a motorcycle that was struck by a car at a presumed high rate of speed. There was reportedly a brief loss of consciousness, although when the first responders arrived, the patient was complaining of pain in both her hands and wrists, as well as severe hip pain.

The patient was hemodynamically stable during transport. Blood pressure on arrival is 130/78 mm Hg, with a heart rate of 90 beats/min. Her O2 saturation is 97% with supplemental oxygen administered by nasal cannula.

As you begin your primary survey, the patient responds appropriately to you: She tells you her name and where she is from. Her medical history is significant for migraines, and her surgical history is significant for a prior cholecystectomy and tubal ligation. Primary exam overall appears normal, except for obvious deformities in both wrists.

As you begin your secondary survey, the radiology technicians obtain portable chest and pelvis radiographs (latter shown). What is your impression?


Radiograph of openbook pelvic fracture


There is evidence of significant widening of the pubic symphysis. This injury results in a disruption of the normal pelvic ring. Such fractures are typically referred to as open-book pelvic fractures. Usually the result of high-energy trauma, they can also be associated with bladder and/or vascular injuries.

Orthopedics was consulted for management of this injury. Prompt stabilization with an external binder may help reduce complications. The patient will ultimately require some form of external or internal fixation.

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