Background: Advanced Trauma Life Support guidelines strongly recommend obtaining anteroposterior (AP) pelvis radiographs when evaluating patients with traumatic injuries. Recently, there has been a trend at our institution to forego AP pelvis radiographs, and to obtain computed tomography (CT) scans as the initial imaging modality of the pelvis instead. Lifesaving interventions, such as the application of a pelvic binder, can be delayed due to the time it takes to complete a primary survey and a CT scan. This study aims to evaluate the effects of bypassing an AP pelvis radiograph on the management of acute traumatic dislocations of the hip. Methods: We performed a retrospective review at a single level-1 trauma center over a 2-year period. Current procedural terminology codes were used to identify patients with traumatic hip dislocations and fracture dislocations that required reduction. We then identified whether an AP pelvis radiograph or pelvis CT was performed. Timing of reduction, need for repeat pelvis CT, radiation exposure, and cost of CT imaging were recorded. Results: There were 52 patients identified with traumatic dislocation or fracture dislocation of the hip. Of those, there were 18 patients who had a CT performed with a dislocated hip (34%), and 9 patients who had a CT identifying the hip dislocation without a prior AP pelvis performed for evaluation. Time to reduction for the 18 patients who had a CT performed was greater than for the 34 patients who had reduction following AP pelvis (200 minutes vs 116 minutes, P = 0.01). The 14 patients that required a repeat CT after reduction had greater amounts of radiation exposure compared to the 29 patients that did not require a repeat CT (2,233mGy-cm vs 1,142mGy-cm, P = 0.004). Conclusion: The AP pelvis radiograph remains valuable for the early identification of hip dislocations, which allows for a faster time to reduction. Ignoring or failing to obtain the AP pelvis radiograph leads to unnecessary delay in reduction and increased radiation exposure.
Khwaja, Ansab; Brad Askam; Matt Morin; and Aditya Manoharan. "The Importance of the Screening Anteroposterior Pelvis Radiograph in Trauma Patients: A Level-1 Trauma Center's Experience with Traumatic Hip Dislocations." Western Journal of Orthopaedics 9, 1 (2020). https://digitalrepository.unm.edu/wjo/vol9/iss1/26