E1309. Do You Know Your Pelvic Osseous Pathways?
  1. Atif Ali; UTHeath McGovern Medical School
  2. Saagar Patel; UTHeath McGovern Medical School
  3. Parth Patel; UTHeath McGovern Medical School
  4. Manickam Kumaravel; UTHeath McGovern Medical School
Pelvic fractures are often some of the most complicated and life-threatening trauma-related injuries due to the complex anatomy and abundant vascular supply. It is crucial for the radiologist to share a “common language” with the orthopedic surgeon to allow for rapid assessment and treatment. The treatment strategy must consider the hemodynamic status of the patient, the anatomic dysfunction of the pelvic ring, and the related neurovascular injuries. A uniform classification system, such as the widely adopted Young and Burgess, allows for rapid, accurate communication between multidisciplinary teams to treat pelvic ring injuries. The Young-Burgess classification system provides an algorithmic approach to assessing injury and categorizing pelvic ring fractures. Understanding injury patterns results in rapid, precise identification of anatomical disruption and allows for orthopedic surgical intervention. Following surgical intervention and hardware placement, complications such as screw displacement, infection, and abscess formation can occur. Understanding osseous fixation pathways and recognizing common complications allows for optimal management of the postsurgical patient.

Educational Goals / Teaching Points
Review relevant clinical anatomy and pathophysiology of pelvic ring fractures. Comprehend the clinical significance of the Young Burgess classification system and the consequences of force distribution in the pelvic ring. Be aware of the expected imaging findings and commonly associated complications with post-operative hardware placement, focusing on osseous fixation pathways. Understand the placement of hardware using the osseous fixation pathways and possible complications

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomy of the pelvis including define the anatomic pelvic ring, review normal radiographic landmarks and alignment, and discuss the basis of the osseous fixation pathways for structural integrity. Imaging evaluation of the pelvic injury including multiple radiographs with CT imaging and 3D reconstructions, understand the role of osseous “bone tunnels.” Pathophysiology of traumatic pelvic ring fractures including a brief discussion of force distribution in the AP and lateral planes. Discuss the pelvic ring fracture classification system (Young-Burgess) including anterior-posterior types 1,2, and 3, lateral compression types 1, 2, and 3, and vertical shear. Review the orthopedic osseous fixation pathways associated with each type of injury using radiographs and videos. Review imaging findings of common complications following osseous fixation.

Radiologists play a crucial role in the rapid assessment and categorization of pelvic ring fractures using the universal Young-Burgess classification system and need to be aware of the hardware placement using osseous fixation pathways. Advanced knowledge of the osseous fixation pathways will help in the identification and evaluation of appropriate placement and identify complications.