Do initial radiographs agree with crash site mechanism of injury in pelvic ring disruptions? A pilot study

Ken F. Linnau, C. Craig Blackmore, Robert Kaufman, Thuc Nghi Hoang Nguyen, Milton L. Routt, Lloyd E. Stambaugh, Gregory Jurkovich, Charles N. Mock

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

OBJECTIVE: Direction of injury force inferred from pelvic radiographs may be used in trauma care to predict associated injuries and guide intervention. Our objective was to compare injury direction determined from anteroposterior (AP) pelvic radiographs with injury forces determined from crash site investigation. MATERIALS AND METHODS: We studied all 28 subjects from the Crash Injury Research Engineering Network (CIREN) database who met inclusion criteria of pelvic ring disruption, single-event crash, restrained front-seat occupant, diagnostic-quality pelvic radiography, and complete crash investigation data. Assessment of diagnostic quality of pelvic radiography was made by 2 radiologists who were blinded to all other subject information. Crash site investigation data included principal direction of force (PDOF), crash magnitude, and passenger compartment intrusion. An orthopedic trauma surgeon and a fellowship-trained emergency radiologist independently assessed the pelvic radiographs to determine the injury PDOF and the Young-Burgess and Tile fracture classifications, with disputes resolved by an additional emergency radiologist. Agreement between injury forces and pelvic radiographs was assessed using the kappa statistic. RESULTS: The PDOF was anterior in 9 (32%) and lateral in 19 (68%) subjects. The readers agreed with the crash primary direction of force in 21 (75%) subjects (κ = 0.42). In subjects with lateral PDOF, agreement was 89% (17/19) compared to 44% for anterior PDOF (4/9). Interobserver agreement for the Young and Tile classification schemes was moderate (weighted kappa 0.44 and 0.54, respectively). CONCLUSION: Crash site investigation and pelvic radiography may provide conflicting information about primary direction of injuring forces. Presumed anterior impact based on PDOF is not in consistent agreement with the pattern of injury evident on the AP pelvic radiograph.

Original languageEnglish (US)
Pages (from-to)375-380
Number of pages6
JournalJournal of Orthopaedic Trauma
Volume21
Issue number6
DOIs
StatePublished - Jul 1 2007
Externally publishedYes

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Wounds and Injuries
Radiography
Emergencies
Direction compound
Dissent and Disputes
Databases
Research
Radiologists

Keywords

  • Clinical decision making
  • Crash reconstruction
  • Injury mechanism
  • Pelvic fracture
  • Radiography

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Linnau, K. F., Blackmore, C. C., Kaufman, R., Nguyen, T. N. H., Routt, M. L., Stambaugh, L. E., ... Mock, C. N. (2007). Do initial radiographs agree with crash site mechanism of injury in pelvic ring disruptions? A pilot study. Journal of Orthopaedic Trauma, 21(6), 375-380. https://doi.org/10.1097/BOT.0b013e31809d5983

Do initial radiographs agree with crash site mechanism of injury in pelvic ring disruptions? A pilot study. / Linnau, Ken F.; Blackmore, C. Craig; Kaufman, Robert; Nguyen, Thuc Nghi Hoang; Routt, Milton L.; Stambaugh, Lloyd E.; Jurkovich, Gregory; Mock, Charles N.

In: Journal of Orthopaedic Trauma, Vol. 21, No. 6, 01.07.2007, p. 375-380.

Research output: Contribution to journalArticle

Linnau, KF, Blackmore, CC, Kaufman, R, Nguyen, TNH, Routt, ML, Stambaugh, LE, Jurkovich, G & Mock, CN 2007, 'Do initial radiographs agree with crash site mechanism of injury in pelvic ring disruptions? A pilot study', Journal of Orthopaedic Trauma, vol. 21, no. 6, pp. 375-380. https://doi.org/10.1097/BOT.0b013e31809d5983
Linnau, Ken F. ; Blackmore, C. Craig ; Kaufman, Robert ; Nguyen, Thuc Nghi Hoang ; Routt, Milton L. ; Stambaugh, Lloyd E. ; Jurkovich, Gregory ; Mock, Charles N. / Do initial radiographs agree with crash site mechanism of injury in pelvic ring disruptions? A pilot study. In: Journal of Orthopaedic Trauma. 2007 ; Vol. 21, No. 6. pp. 375-380.
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abstract = "OBJECTIVE: Direction of injury force inferred from pelvic radiographs may be used in trauma care to predict associated injuries and guide intervention. Our objective was to compare injury direction determined from anteroposterior (AP) pelvic radiographs with injury forces determined from crash site investigation. MATERIALS AND METHODS: We studied all 28 subjects from the Crash Injury Research Engineering Network (CIREN) database who met inclusion criteria of pelvic ring disruption, single-event crash, restrained front-seat occupant, diagnostic-quality pelvic radiography, and complete crash investigation data. Assessment of diagnostic quality of pelvic radiography was made by 2 radiologists who were blinded to all other subject information. Crash site investigation data included principal direction of force (PDOF), crash magnitude, and passenger compartment intrusion. An orthopedic trauma surgeon and a fellowship-trained emergency radiologist independently assessed the pelvic radiographs to determine the injury PDOF and the Young-Burgess and Tile fracture classifications, with disputes resolved by an additional emergency radiologist. Agreement between injury forces and pelvic radiographs was assessed using the kappa statistic. RESULTS: The PDOF was anterior in 9 (32{\%}) and lateral in 19 (68{\%}) subjects. The readers agreed with the crash primary direction of force in 21 (75{\%}) subjects (κ = 0.42). In subjects with lateral PDOF, agreement was 89{\%} (17/19) compared to 44{\%} for anterior PDOF (4/9). Interobserver agreement for the Young and Tile classification schemes was moderate (weighted kappa 0.44 and 0.54, respectively). CONCLUSION: Crash site investigation and pelvic radiography may provide conflicting information about primary direction of injuring forces. Presumed anterior impact based on PDOF is not in consistent agreement with the pattern of injury evident on the AP pelvic radiograph.",
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AU - Linnau, Ken F.

AU - Blackmore, C. Craig

AU - Kaufman, Robert

AU - Nguyen, Thuc Nghi Hoang

AU - Routt, Milton L.

AU - Stambaugh, Lloyd E.

AU - Jurkovich, Gregory

AU - Mock, Charles N.

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N2 - OBJECTIVE: Direction of injury force inferred from pelvic radiographs may be used in trauma care to predict associated injuries and guide intervention. Our objective was to compare injury direction determined from anteroposterior (AP) pelvic radiographs with injury forces determined from crash site investigation. MATERIALS AND METHODS: We studied all 28 subjects from the Crash Injury Research Engineering Network (CIREN) database who met inclusion criteria of pelvic ring disruption, single-event crash, restrained front-seat occupant, diagnostic-quality pelvic radiography, and complete crash investigation data. Assessment of diagnostic quality of pelvic radiography was made by 2 radiologists who were blinded to all other subject information. Crash site investigation data included principal direction of force (PDOF), crash magnitude, and passenger compartment intrusion. An orthopedic trauma surgeon and a fellowship-trained emergency radiologist independently assessed the pelvic radiographs to determine the injury PDOF and the Young-Burgess and Tile fracture classifications, with disputes resolved by an additional emergency radiologist. Agreement between injury forces and pelvic radiographs was assessed using the kappa statistic. RESULTS: The PDOF was anterior in 9 (32%) and lateral in 19 (68%) subjects. The readers agreed with the crash primary direction of force in 21 (75%) subjects (κ = 0.42). In subjects with lateral PDOF, agreement was 89% (17/19) compared to 44% for anterior PDOF (4/9). Interobserver agreement for the Young and Tile classification schemes was moderate (weighted kappa 0.44 and 0.54, respectively). CONCLUSION: Crash site investigation and pelvic radiography may provide conflicting information about primary direction of injuring forces. Presumed anterior impact based on PDOF is not in consistent agreement with the pattern of injury evident on the AP pelvic radiograph.

AB - OBJECTIVE: Direction of injury force inferred from pelvic radiographs may be used in trauma care to predict associated injuries and guide intervention. Our objective was to compare injury direction determined from anteroposterior (AP) pelvic radiographs with injury forces determined from crash site investigation. MATERIALS AND METHODS: We studied all 28 subjects from the Crash Injury Research Engineering Network (CIREN) database who met inclusion criteria of pelvic ring disruption, single-event crash, restrained front-seat occupant, diagnostic-quality pelvic radiography, and complete crash investigation data. Assessment of diagnostic quality of pelvic radiography was made by 2 radiologists who were blinded to all other subject information. Crash site investigation data included principal direction of force (PDOF), crash magnitude, and passenger compartment intrusion. An orthopedic trauma surgeon and a fellowship-trained emergency radiologist independently assessed the pelvic radiographs to determine the injury PDOF and the Young-Burgess and Tile fracture classifications, with disputes resolved by an additional emergency radiologist. Agreement between injury forces and pelvic radiographs was assessed using the kappa statistic. RESULTS: The PDOF was anterior in 9 (32%) and lateral in 19 (68%) subjects. The readers agreed with the crash primary direction of force in 21 (75%) subjects (κ = 0.42). In subjects with lateral PDOF, agreement was 89% (17/19) compared to 44% for anterior PDOF (4/9). Interobserver agreement for the Young and Tile classification schemes was moderate (weighted kappa 0.44 and 0.54, respectively). CONCLUSION: Crash site investigation and pelvic radiography may provide conflicting information about primary direction of injuring forces. Presumed anterior impact based on PDOF is not in consistent agreement with the pattern of injury evident on the AP pelvic radiograph.

KW - Clinical decision making

KW - Crash reconstruction

KW - Injury mechanism

KW - Pelvic fracture

KW - Radiography

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