Magnetic Resonance Imaging in Pelvic Fractures - Part 1: Which Criteria Lead Us to Supplementary MRI Diagnostics? / Die Kernspintomografie bei Beckenfrakturen ­ Teil 1: Welche Kriterien veranlassen uns zur ergänzenden MRT-Diagnostik?

INTRODUCTION: Isolated pelvic fractures are relatively rare with an incidence of 3 - 6% of all fractures, but their incidence in polytraumatized individuals increases to 25%. The S3 guideline Polytrauma gives a clear recommendation for diagnostics by means of pelvic radiography (X-ray) and computed tomography (CT). A recommendation for the diagnosis by means of magnetic resonance tomography (MRI) especially in patients with low energetic/missing trauma does not currently exist. It is unclear on the basis of which criteria the MRI can be indicated in pelvic fractures. The aim of our study was therefore to retrospectively record indications for the indication of MRI in pelvic fractures - with adequate as well as inadequate trauma. MATERIAL AND METHODS: In a retrospective clinical study, a total of 140 patients (median 68 years, range 15 - 97, 75 female, and 66 male) with a pelvic fracture were included in the study over a period of three years. Overall, the trauma mechanism revealed 73 adequate and 67 inadequate fractures. 31/140 patients had undergone MRI of the pelvis in addition to a CT/X-ray scan. The two subgroups "with MRI" and "without MRI" were analyzed with regard to the parameters "sex", "age", "adequacy of the trauma", "fracture localization", "duration of admission to imaging", "type of therapy" and "duration to surgery" compared. RESULTS: It was shown that the MRI diagnosis was performed especially in female, elderly patients (81 years, range 19 - 94 years). Patients with inappropriate trauma have received MRI more frequently (74%) than patients with adequate trauma (26%). With regard to fracture localization no differences could be shown. The MRI was performed on a median 4 days after the CT examination. Regarding the decision "conservative" vs. "operationally" our two groups without and with MRT tended to differ not. Patients with MRI were operated on median 2 days later than patients who did not receive MRI. CONCLUSIONS: Pelvic fracture MRI should be performed primarily in elderly female patients without adequate trauma. In patients with adequate trauma, MRI is of low value, especially as MRI diagnostics are performed with delay, resulting in later surgery.

Magnetic Resonance Imaging in Pelvic Fractures - Part 2: Gaining Information and Clinical Therapeutic Relevance. / Die Kernspintomografie bei Beckenfrakturen ­ Teil 2: Informationszugewinn und klinische Therapierelevanz.

BACKGROUND: Magnetic resonance and computed tomography (MRI, CT) has been known to compare the sensitivity for the detection of pelvic fractures with others. It is unclear whether MRI imaging beyond CT leads to therapy change. The aim of our study is to determine the information gained from MRI in the diagnosis of pelvic fractures and to reduce the effects on the form of therapy. PATIENTS AND METHODS: In a retrospective, clinical study, 31 patients with pelvic fracture and CT and MRI imaging (median 81 ± 20 years, 22 female and 9 male) were examined. There was a classification according to AO classification for adequate or FFP classification for inadequate fractures. In addition, vascular, muscular, haematomatous and organic concomitant injuries as well as bone marrow edema and additional secondary findings requiring evaluation were evaluated. The type of therapy (conservative vs. surgical) and a possible type of therapy change were documented for each patient. Exact test according to Fisher was tested orienting. RESULTS: Overall, MRI showed a greater fracture rate of pelvic fractures in 29% (n = 9) patients than CT. Four type I fractures according to FFP classification were identified as type II fractures and 4 type II fractures as type IV fractures. One type B1 fracture according to AO classification was found to be C2 fracture on MRI. Fisher's Exact Test found that the parameters "adequacy of trauma" and "fracture type change" by MRI were p = 0.38. MRI showed a total of 82 concomitant injuries, CT 31. Overall, MRI gained information in 75% (n = 24) of all patients examined. A change from conservative to operative after MRI took place in 2 patients. No patient was surgically changed from planned surgery to conservative. The extent to which MRI caused changes within one form of therapy (conservative, operative) could not be determined retrospectively. In 18% of patients with an inadequate fracture, however, according to the literature, the treatment regimen would have changed pro forma. CONCLUSION: In summary, it can be stated that the MRI in our study provided an information gain in the case of adequate and inadequate pelvic fractures as well as their accompanying injuries and that a possible therapeutic relevance of this information gain could be obtained specially at the inadequate fractures showed.