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Study: MRI evaluates pelvic ring ligamentous anatomy, injury

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Magnetic resonance imaging can evaluate ligamentous anatomy and injury about the pelvic ring, presenting a role for MRI in the management of patients with external rotation pelvic injuries, according to recently published data.

“Our study showed that MRI can be used to evaluate the sacrospinous, sacrotuberous, anterior and posterior sacroiliac ligaments in most pelvises and that MRI findings in injured pelvises generally correlated with the Young-Burgess classification,” Joshua L. Gary, MD,  assistant professor of the Department of Orthopaedic Surgery at the University of Texas Health Science Center at Houston, told Orthopedics Today.

In the study, 21 patients with 25 acute external rotation injuries of the hemipelvic bones and a control group of 26 patients without pelvic ring injury underwent MRI protocol at a level I trauma center. Main outcome measures included integrity of sacrospinous, sacrotuberous, anterior sacroiliac and posterior sacroiliac ligaments and pelvic floor musculature.

Study results showed visualization was possible for 91% of sacrospinous, 100% of sacrotuberous, 98% of anterior sacroiliac ligaments, 91% of posterior sacroiliac ligaments and 100% of pelvic floor musculature for all studied structures. In contrast to ligament injury observed with all injured pelves, researchers identified no injuries in the control group.

“However, we found two patterns within the anterior-posterior compression type II (APC-II) group: one with symphyseal and anterior sacroiliac ligament disruption only (50%) and one with those injuries in addition to disruption of the sacrospinous ligament (50%).  This suggests two distinct injury patterns within the Young-Burgess APC-II group, where treatment is currently controversial regarding fixation of the anterior and posterior pelvic ring. In contrast, traumatologists almost uniformly agree on the treatment of Young-Burgess APC-I and APC-III injuries. These two patterns, APC-IIa and APC-IIb, may require different fixation strategies to restore stability,” Gary said.

He also said that future prospective research using this information and a better understanding of the continuous spectrum of pelvic ring disruption may help provide a resolution.

Reference:

Gary JL. J Orthop Trauma. 2014;doi:10.1097/BOT.0b013e318299ce1b.

Disclosure: Gary is on the editorial board for the Journal of Bone and Joint Surgery and the Journal of Orthopaedic Trauma.