Assessment #1 case #7

fracture of the ilium at iliac crest

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Acute fracture in left iliac bone and possibly more smaller fractures. This image is very dark for some reason

right inferior and superior pubic rami fracture and widening of pubic symphysis and likely right SI joint, indicating instability.

Acute displaced right obturator ring fracture with inferior placement of the fractured fragment.

displaced r obturator ring fx, disrupted pubic symphysis marked diastasis

Acute fractures of the superior and inferior pubic rami on the right with widening of the pubic symphysis, an unstable fracture.

FINDINGS/IMPRESSION:

There are markedly displaced fractures of the right superior and inferior pubic rami, with inferior displacement of the now free-floating fracture fragment., an unstable pelvic injury. There is also slight widening of the right SI joint. The left SI joint is normal .The femoral heads appear concentrically located on this single view. The visualized soft tissues are normal.

Acute displaced fractures of the right inferior and superior pubic rami. Widening of the right sacroiliac joint and fracture of the left sacrum. Given complex pelvic fractures, recommend further evaluation with CT cystogram.

Acute unstable pelvic ring injury with displaced fracture through the superior and inferior pubic rami. There is pubic symphysis and right SI joint diastasis. Question sacrum fracture with small ossific fragment projecting over the R SI joint. The hips are located. Recommend CT for further evaluation.

Supr infer right pubic rim fracture with widening of symphysis and left iliac crest avulsion fracture.

Pubic symphysis diastasis. Displaced fractures of right superior and inferior pubic rami. Right sacroiliac joint space widening. Small probable Avulsion fragment adjacent to right AIIS.

Acute unstable vertical shear pelvic ring injury with diastasis of the pubic symphysis, inferiorly displaced R obturator ring fractures, and widening of the R sacroiliac joint with adjacent avulsion fracture fragment from the sacral ala. CT could further evaluate.

acute displaced fracture of right iliac wing with inferior displacement of fracture fragment.
additional joint space wideneing of the right sacroiliac joing and fracture fragment.

complete displaced fracture of superior and inferior pubic rami with dissociation of the pubic symphysis

Acute, communicated fracture of the right superior and inferior pubic rami. Wide diastasis of the pubic symphysis.

Unstable pelvis

Acute open book fracture of the pelvis. There is fracture of the superior and inferior left rami with inferior displacement of the distal fragment. There is widening of the right SI joint. There is a nondisplaced fracture of the left inferior sacral ala and probable fracture of the inferior medial sacral crest.

Acute mildly displaced fracture of the right superior and inferior pubic rami. Possible additional fracture involving the left inferior sacrum. Mild widening of the left right SI joint. Recommend comparison to prior studies.

open book fracture with right obturator ring fracture.

Severe diastasis of pubic symphisis, widening of R SI joint, displaced sup and inf R pubic rami fx, and questionable sacral fracture.

multiple fxs

Acute fractures of the superior and inferior pubic rami on the right with widening of the pubic symphysis, an unstable fracture.

Right obturator ring fracture with inferiolateral displacement of the ischial fracture fragment. The pubic symphisis is widened and malaligned. The hips and sacroiliac joints remain located. No additional fractures are noted. The soft tissues appear grossly normal.

Mildly inferiorly displaced superior and inferior right pubic ramus fractures. No definite femoral neck fractures. Possible widening of the left SI joint.

left obturator ring fracture with significant diastasis

Acute inferiorly displaced fractures of the right superior pubic ramus and ischial ramus with diastasis of the pubic symphysis. Recommend cystogram to assess for bladder injury and CTA for vascualr injury.
Left inferior sacral ala fracture.
Right greater than left sacroiliac joint widening.
Left hip dislocation.

pubic symphysis diastasis, widening of the right SI joint; fractures of the right superior and inferior pubic rami; possible fracture of the left iliac or left aspect of sacrum

displaced fracture of inferior and superior pubic rami with disruption of pubic symphisis and widening of right SI joint

displaced fractures of the superior and inferior pubic rami with separation of the pubic symphysis. widening of the right SI joint with bony fragment in the joint space, concerning for acute fracture of the right sacral ala

Displaced fracture of the right superior pubic ramus and inferior pubic ramus with widening of the right sacrioiliac joint and pubic symphysis.

Open book pelvic fx. Widened R SI.

Acute fracture of the right superior and inferior pubic rami fracture and right sacral ala fracture.

Acute displaced fracture of the superior and inferior pubic ramus.

Unstable pelvic ring injury with widened pubic symphysis and widened bilateral SI joints.
Acute displaced fractures of the superior right pubic ramus and right ischipubic ramus.

unstable pelvic ring injury as below:
1. superior and inferior ramus, both displaced. Widening of pubic symphysis
2. left iliac wing nondisplaced fx.
3. widening of the right si joint.
4. right acetabular fx
Recommend CT.

query acute fx 2nd sacral ala on the left. attn on ct

Acute, unstable pelvic ring injury. Widening of the pubic symphysis and the right SI joint. Acute fractures through the right pubic root and right inferior pubic ramus with x cm of displacement.

Acute unstable open book pelvic ring injury (APC III) with widening of the anterior and posterior bilateral sacroiliac joints, pubic symphyseal diastasis with acute fractures of the superior and inferior right pubic rami with approximately __ cm inferior displacement. Additionally noted transverse fracture of the coccyx and mildly displaced avulsion fracture from the right sacrum along the inferior border of the right sacroiliac joint. Query acute nondisplaced left L5 transverse process fracture.

Increased soft tissue density in the pelvis with superior displacement of bowel gas, which may indicated associated pelvic hematoma, which can be further assessed on forthcoming CT C/A/P.

Small triangular density projecting lateral to the right iliac wing may represent a displaced avulsion fracture versus retained foreign body, such as glass.

Acute fracture of the right superior and inferior pubic rami with inferior displacement by X cm. Widening of the pubic symphysis by X cm with inferior displacement of the right pubic body. Inferior translation of the right hemipelvis by X cm with widening of the right SI joint. Query avulsion fracture of right superolateral sacrum. Findings consistent with acute unstable pelvic injury.
Triangular opacity projects over soft tissues lateral to right ASIS, concerning for foreign body.

Disruption of the right SI joint. Widening of the pubic symphysis. Displaced fractures of the inferior and superior right pubic rami. Findings consistent with a vertical shear type injury.

pelvic fx.

There is an open book pelvis fracture with widening of the bilateral sacroiliac joints, and pubis symphysis rupture and fracture of the right superior and inferior pubic rami.

Unstable pelvic ring fractures with acute displaced obturator ring fracture involving the superior and inferior pubic rami. Diastasis of the pubic symphesis. Right minimally displaced transverse acetabular fracture. Widening of the bilateral sacroiliac joints. Acute nondisplaced Zone 2 left sacral fracture. Acute fracture thorugh the left iliac crest .

Acute displaced fracture of the right obturator ring. Widening of the right SI joiint and pubic symphysis.

Acute likely globally unstable pelvic ring fracture with the following visible radiographic components:

Acute fracture of the right obturator ring with displaced pubic root and inferior pubic ramus fractures.

Pubic symphysis diastasis measuring x cm with upward shearing of the left pelvis.

Widening of the right SI joint. No visible iliac wing fracture.

Acute, unstable, pelvic ring injury with diastasis of the pubic symphysis measuring X and widening of the bilateral anterior and posterior sacroiliac joints.
Acute minimally dsplaced fracture of the sacrum.
acute, displaced fractures of the right superior and inferior pubic rami with X CM of inferior displacement of the distal fracture fragments.
Acute transverse fracture through the right acetabulum.
Radiopaque density lateral to the right ASIS, which may represent and avulsion fracture of a forign body.
Consider CT for further evaluation if it will effect clinical management.

R inf and sup pubic rami fx’s with inferior dislocation of the medial fx fragment with widening and vertical offset of the symphysis pubis. Possible widening of R SI joint.

Unstable pelvic ring fracture

unstable pelvic ring injury with widening of the r>l SI jts, diastasis of pubic symphsis measring xxx and verticle shear injury. acte mildly comm fracture involving sperior and inferior pubic rami with xxx inferior displacement and xxx override.
likely additional acute r posterior acetablar wall fx

Acute right superior and inferior obturator ring fractures with rotation of the fracture fragment.
Acute transverse nondisplaced fracture of the right acetabulum.
Widening of the right sacroiliac joint with small ossific fragment at the inferior portion.
Together these findings are concerning for unstable pelvic injury.

Unstable pelvic ring injury with widening of pubic symphysis, superior translocation of the left hemipelvis, and diastasis of the right SI joint. There is an acute fracture of the right obturator ring with inferior displacement of the fragment. There is a nondisplaced acute fracture of the left sacral ala.

right pubic and sacral

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pubic joint dislocation and R obturator ring fracture, R SI joint may be widened

Acute unstable pelvic ring fracture with right superior and inferior displaced pubic rami fractures, widening of the right SI joint and pubic symphysis diastasis. Acute bilateral sacral ala fractures. Bony fragment lateral to the right iliac wing that may represent right ilac crest avulsion fracture. Lucency along the mid penile urethra that may represent penile urethral injury.

Unstable pelvic ring injury including the following:
Widening of the right greater than left sacroiliac joints.
Widening of the pubic symphysis.
Acute fractures of the superior and inferior right pubic rami with inferiolateral displacement of the fracture fragment.
Acute fracture of the right sacrum.
Attention on forthcoming cross sectional imaging.

Acute fractures through the right superior and inferior pubic rami with diastasis of the pubic symphisis. Widening of the right SI joint, and possibly the left. Findings concerning for open book pelvic ring injury.

APC II
left sacral Dennis 1

AP compression-type pelvic ring fracture with diastasis of bilateral SI joints and pubic symphysis. Left sacral alar fracture, incomplete. Inferiorly-displaced right obturator ring fracture. Transverse right acetabular fracture. Left L5 TP fx.

Acute unstable pelvic ring injury evidenced by widened pubic symphysis > 2.5 cm and widened bilateral SI joints, consisting of a right superior and inferior pubic rami fractures. No definite sacral or iliac fractures.

Acute displaced right superior and inferior pubic rami fractures.

left iliac Ala fracture. right displaced inferior and superior pubic rami fracture with widening of the pubic symphysis

Unstable pelvis

Unstable pelvic fracture including moderately displaced right pubic rami fractures. Suspect associated right pelvic hematoma, possibly representing vascular injury.

Acute displaced fracture of the right superior and inferior pubic rami with separation of the pubic symphysis.
suspect fracture of the right sacroiliac joint. Recommend CT of the pelvis.

Acute inferiorly displaced fracture of the obturator ring with widening of the pubic symphysis.

There is an acute mildly displaces left sacral fracture.

There is mild widening of the right sacroiliac joint.

Unstable pelvic ring with acute displaced fractures involving the right superior and inferior pubic rami with inferiorly displaced right obturator ring
Increased pubic symphysis interval

fx

Right superior and inferior rami fx with pelvic instability

Acute displaced fracture of the right superior and inferior pubic rami with widening of the pubic symphysis.
Query widening of the right SI joint.

fx

There is diastasis of the pubic symphysis with moderately displaced fractures of the right superior and inferior pubic rami fractures with possible involvement of the acetabular roof.

The sacral bones are not fully visualized and likely fractures.

The sacroiliac joints appear slightly widened, right greater than left.

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Caudally displaced fracture of the RIGHT obturator ring at the superior pubic ramus and the ischiopubic ramus

Widening of the RIGHT sacroiliac joint and the pubic symphysis

unstable sup/inf rami fx

Displaced obturator ring fracture w superior and inferior pubic rami

Vertical fracture involving the left iliac wing. Left sacral minimally displaced vertical fracture. Medial aspect of left iliac bone fracture.

Fracture of the right sacrum/iliac bone, left iliac wing, and right obturator ring with widening of the pubic symphysis. Diastasis of the right sacroiliac joint.

Acute fracture through the right upper and lower pubic bone with pubic symphysis and right sacroiliac joint diastasis.

Moderately displaced fracture of the superior and inferior pubic ramus on the right, with extension into the posterior acetabulum. widening of the pubic symphysis and right sacroiliac joint. Bilateral femoral heads are located. Linear lucency just medial to the left sacroiliac joint may represent an additional nondisplaced fracture of the sacrum.

Vertical shear injury with left hemipelvic translocation with diastasis of the pubic symphysis. This is an unstable pelvic fracture. Acute fracture of the left sacral wing and widening of the right sacroiliac joint.

Fracture through the superior and inferior right pubic rami with pubic diastasis, consistent with an unstable pelvic fracture. Transverse and anterior column fracture of the right acetabulum. There is a left sacral fracture and widening of the right sacroiliac joint. Normal appearance of bilateral hip joints with no evident femoral head or neck fracture.

Unstable pelvic fracture with right sided obturator ring fracture of the superior and inferior pubic rami with inferior displacement of the fracture fragment as well as widening of the right SI joint in the inferior aspect. There is also a possible right sided acetabular fracture. No other acute fracture. Hips are located.

Multiple acute pelvic fractures including:
1) Widened right SI joint with calcifications within the SI joint space, concerning for avulsion fracture.
2) R transverse acetabular fracture
3) left Sacral bone fracture (denis zone 1)
4) R obturator fracture through the superior and inferior ischiopubic rami with 1 shaft width inferior displacement
5) associated pubic symphysis widening
– altogether make this an unstable pelvic fracture.

CT could further evaluate for soft tissue/vascular injury.

Acute unstable pelvic ring injury with fractures of the right inferior and superior pubic ramus and diastasis of the pubis.
Acute fracture through the anterior and posterior walls of the acetabulum with extension to the pubic root.
Acute fracture through the inferior aspect of the left sacral ala.

Acute unstable pelvic ring injury including widening of the right greater than left sacroiliac joints, acuter fracture of the left sacral ala, acute fracture of the right superior and inferior pubic rami with widening of the pubic symphysis and acute right acetabular fracture.

Unstable pelvic ring injury involving right SI joint widening, fractures of the right pubic ramus and ischiopubic ramus. Likely right acetabular fracture. Recommend follow up CT for further evaluation.

Widening of the pubic symphysis up to *** cm and widening of the right SI joint, with acute inferiorly displaced fractures of the superior and inferior right pubic rami. Vertical shear injury is a concern, attention to vascular structures on forthcoming CT CAP. Question right acetabular wall fracture. Bilateral hips are located. Lucency of the left iliac crest favored to reflect overlying bowel gas.

Acute unstable pelvic ring injury. Fractures of the superior and inferior pubic rami with inferior displacement of the fracture fragment. Pubic symphysis diastasis. Right SI joint diastasis. BL nondisplaced transverse acetabular fractures. Linear lucency projecting over the left ilium may represent acute fracture.

Acute vertical shear unstable pelvic ring injury with severe widening of the pubic symphysis measuring xx cm, superior translation of the left hemipelvis and widening of the bilateral SI joints. Acute, displaced fractures of the right pubic root and ischiopubic ramus with xx cm inferior displacemnt of the medial fracture fragment. Acute facture of the left inferior sacral ala and probable bilateral iliac wing fracures. Transverse right acetabular fracture.

Acute unstable pelvic ring injury involving displaced comminuted fractures of the right superior and inferior pubic rami, transverse fracture through the right acetabulum, and bilateral sacroiliac joint widening, right greater than left. Approximately 3 cm of pubic symphysial widening.

The hips are located.

-Diastasis of the pubic symphysis >5cm indicated likely unstable open book pelvic ring injury.
-Fracture through the superior and inferior pubic rami on the right.
horizontal lucency through the right acetabulum that could represent acetabular fracture.
-Diastasis of the bilateral sacroliliac joints with an ossific fragment on the right the could represent sacral fracture.
-Recommend CT for further characterization.

LC III injury with pubic diastasis >2.5 cm, right greater than left SI joint widening, and disruption of the S3 arcuate line of the sacrum, Minimally displaced acute iliac crest fracture extending through the iliac body and medially to the medial border of the iliac wing. Comminuted fracture of the right obturator ring at the pubic root and ischiopubic ramus with inferior displacement of the medial obturator ring fracture fragment, which overlies the obturator foramen. Acute fracture of the right acetabulum (anterior wall) with disruption of the anterior and posterior columns. Recommend CT for further evaluation as well as consideration of CTA to assess for potential vascular injury given involvement of the right obturator foramen.

Acute APC III/vertical shear injury of the pelvis with widening of the pubic symphysis and widening/superior dislocation of the left sacroiliac joint and widening of the right sacroiliac joint, concerning for unstable pelvic ring injury.
Displaced fracture of the superior and inferior right pubic rami with inferior displacement of the fracture fragment. There is an additional fracture of the right ischium that traverses the right acetabulum.
Acute fracture of the left sacral zone II.
Possible non-displaced fracture of the right femur head.

Unstable pelvic ring with pubic synthesis measuring X
Right tsacroiliac joint widening.
Obtturator ring fractures, including displaced is your pubic ramus and superior tissue ramus involving posterior wall acetabular fracture.

Acute, unstable vertical shear injury of the pelvis with distraction of the pubic symphysis and bilateral SI joints.

Acute, both column fracture of the right acetabulum with mild distraction, although right hip remains located.

Acute comminuted fracture of the superior pubic ramus and non-comminuted fracture of the inferior pubic ramus with approximately 1.5 shaft-width inferior displacement and 1cm lateral displacement/foreshortening. Gas within the pelvis is concerning for open fracture. Correlate with direct inspection.

Small osseous fragment along the inferior margin of the right SI joint, concerning for acute fracture. Recommend CT pelvis for better characterization of fractures.

Small triangular radiopacity lateral to the right iliac bone, possibly a foreign body versus displaced fracture fragment.

Acute unstable vertical shear pelvic ring injury with superior displacement of the left hemipelvis.

Diastasis of the pubic symphysis with bilateral widening of the sacroiliac joints. Ossific fragment with the right inferior SI joint likely represents sacral fracture.

Acute fractures of the inferior and superior rami with inferomedial displacement of the obturator ring and pubic body.

Acute, mildly displaced right acetabular fracture with involvement of the posterior wall and a transverse component.

Triangular shaped density projecting over the soft tissues lateral to the anterior superior iliac spine may represent foreign body.

Recommend further evaluation with CT pelvis.

Instable pelvic ring fracture, including:

Acute fractures of the right superior and inferior rami with one and a half shaft width inferior displacement.

Acute, non displaced transverse fracture of the right acetabulum.

Acute, sagittally oriented fracture of the medial aspect of the iliac crest with extension inferiorly through the SI joint. Diastasis of the right SI joint.

Diastasis of the pubic symphysis.

Small triangular shaped calcific fragment along the right lateral aspect of the ASIS, which is likely related to trauma.

Acute fracture of the left iliac wing with extension into the acetabulum. Acute comminuted fracture of the right pubic rami. Unstable pelvic ring fracture.

Unstable pelvic ring injury with the following components: Widening and offset of the pubic symphysis by x cm (>2 cm), widening of the right SI joint with a small ossific fragment inferiorly possibly representing iliac fracture, right superior and inferior pubic ramus fractures with moderate inferior and lateral displacement, and a right transverse acetabular fracture. CT could be used to further evaluate extent and for occult fractures.

Acute displaced vertical shear fracture involving the right superior and inferior pelvic rami, widening of the right SI joint, lambda type sacral fracture, right acetabular fracture, and pubic symphysis diastasis. Recommend urgent trauma surgery consult, urology consult, CT A/P with contrast for further evaluation.

Acute fracture of the superior and inferior right pelvic ramus with inferior displacement. Diastasis of the pubic synthesis. Bilateral sacroiliac joint space widening.

Pelvic ring injury with widening of the pubic symphysis, acute displaced fractures of the right inferior pubic ramus and right superior pubic ramus with extension into the acteabulum, and widening of the right sacroiliac joint.

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Acute, markedly displaced right obturator ring fracture with involvement of the posterior acetabulum and widening of the pubic symphysis.

Acute comminuted, displaced fractures of the superior and inferior pubic rami with pubic symphysis diastasis > 2.5cm and approximately 1.5 shaft width inferior displacement of the dominant fracture fragment. Acute bilateral fractures of the sacral ala with diastasis of the sacroiliac joints and vertical displacement of the left hemipelvis. These findings are concerning for an acute unstable vertical shear injury, recommend emergent surgical consult and CT CAP for further evaluation.

Acute non-displaced fracture of the left iliac crest.

Acute fracture of the posterior and anterior right acetabular walls.

Acute right vertical shear injury of the pelvis which includes: Widening of the right SI joint. Acute fractures of the superior and inferior pubic rami. Right acetabular fracture.

Acute fracture of the right obturator ring involving ischial ramus and the pubic root, with fracture line extending through the posterior wall of the right acetabulum.

Pubic symphysis diastasis.

Widening of the right SI joint without definite fracture.

These findings are concerning for unstable pelvic fracture. Recommend CT to further characterize.

Acute unstable vertical shear pelvis injury with acute fracutres involving the left hemisacrum, left iliac crest, right acetabulum, and right obturator ring. There is diastasis of the pubic symphysis and right SI joint. CT pelvis is reccomended for further evaluation.

Acute displaced fractures of the right obturator ring involving the superior and inferior ischial tuberosities with extension of the fracture line to involve the acetabulum. Additionally, there is a minimally displaced fracture of the right iliac bone. Diastasis of the pubic symphysis with diastasis of the right sacroilliac joint. APC II injury.

Acute fractures of the right superior and inferior pubic rami with x mm inferior displacement of the fracture fragment. Fracture extends into the right acetabulum.There is x cm diastasis of the pubic symphsysis and widening of the anterior right SI joint. Concerning for unstable pelvic ring injury, recommend CT for further evaluation.
Linear lucency overlying the left iliac wing, query acute fracture.

Acute R superior and inferior pubic ramii fractures with inferior displacement of the fractured component. These is also pubic symphysis diastasis.
Acute both column fracture of the R acetabulum.
Right SI joint diastasis.

A single AP radiograph view of the pelvis is present.

Acute displaced fractures of the right superior and inferior pubic rami are present. There is widening of the pubic symphysis. There is widening of the right SI joint compared to the left. Linear lucencies project over the right acetabulum.

The soft tissues are incompletely visualized in the provided radiograph.

Impression:
1. Acute displaced fractures of the right superior and inferior pubic rami. Bladder injury cannot be excluded on the provided radiograph. Recommend follow up CT with contrast if there is clinical concern.
2. Widening of the pubic symphysis.
3. Widening of the right SI joint.
4. Additionally, linear lucencies project over the right acetabulum may represent fractures, however evaluation is limited with a single provided radiograph.
5. Combined, these findings are suggestive of an open book fracture.

There is an acute displaced fracture of the right pubic ramus and ischium. There is associated displaced fracture of the right sacral ala. There is rotational instability. This is concerning for a type II lateral compression fracture.

Fracture through the L iliac wind
Disatasis of the R greater than L bilateral SI joints
Multiple fractures through the superior and iferior pubic

THere is an unstable pelvis with RIGHT obturator ring fracture, left iliac bone fracture and LEFT sacrum fracture.