Clinical radiographic ct and mri evaluation of pelvic injuries in the elderly: a comparative analysis

Aims of Study: Pelvic injuries in elderly patients are usually missed because osteoporotic cancellous bone fractures of Pelvis are poorly visualized, especially with poor quality portable X rays and this becomes a bigger problem, not only from treatment angle but due to medico legal and consumer forum implications. So, this study was undertaken to compare the results of clinical, radiological, computed tomographic and MR imaging of pelvic injuries. The fragility of bones due to senile osteoporosis, makes the elderly population vulnerable to fractures of the pelvis, following minor trauma. Majority of these fractures are minimally displaced or undisplaced and likely to be missed on clinical and routine conventional radiography (wet films) by junior residents in busy emergency department. A prospective study on various diagnostic modes like clinical, radiographic, CT and MRI, was conducted in elderly patients with low energy pelvic injuries attending emergency department of GMC Jammu from June 2015 to June 2017. Out of 131 patients of low energypelvic trauma, 86 fulfilled the inclusion criteria and consented for the study. The clinical and investigative parameters were evaluated in all the cases by a senior orthopedic surgeon and two senior radiologists. There were 6 5 (75.5%) females and 21 (24.5%) males. Mean age was 72.7(50 – 90) years. Commonest mode of trauma was domestic falls in 62 (72%) of cases. There were 146 fractures and 14 soft tissue injuries. The clinical examination was sensitive in 80.8% cases with low specifity of (58.6%). Plain X rays Pelvis AP view was diagnostic in 69 (80.2%) cases.Computed tomography had an accuracy level of 94.1% and MRI was effective in 97.7% of fracture cases and 85.7% in soft tissue injuries. Posterior ring fractures were missed in 2.3% by MRI, 11.5 by C T scan, 68.6% by Conventional X rays and 14.3% by clinical examination. There were 12 false positive cases clinically, 10cases radiologically, 6 cases in CT and 2 cases of MRI. The false negative cases were 8 in clinical, 12 radiological, 2 in C T and 1 amongst MRI. Conclusion: C T scan of pelvis is highly accurate in picking up most of pelvic fractures (94.1%) in the present study and the study proves that C T scan being easily available in most of the secondary and tertiary care hospitals, should be the investigation of first choice. Its 3D pictures are very useful for the surgeons to understand the spatial displacement of fragments, especially in cases requiring surgical intervention. Contrast enhanced C T is also helpful in delineating soft tissue collections, extravagation of urine or hematoma / pus and can assist aspirations. MRI certainly gives better results than C T in the diagnosis of occult bony as well as soft tissue injuries. MRI is better in efficacy highly sensitive investigation especially in undisplaced fractures in osteoporotic patients but is costly, time consuming and not available in most of secondary care centers in developing countries, hence should be reserved for patients associated with soft tissue injuries or in cases where C T has failed in picking up a fracture.