Additional clinical value of routine CT-imaging in fragility fractures of the pelvis; a prospective cohort study

Fragility fractures of the pelvis (FFP) in elderly patients are an underestimated injury with a significant impact on mobility, independency and mortality similar to hip fracture patients.These isolated anterior pelvic ring fractures are stable fractures that often do not require surgical intervention and patients can be treated with pain guided mobilization. However, a concomitant posterior pelvic ring fracture (cPRF’s) in the form of a sacral fracture is often found when properly looked for. For adequate detection, Computed Tomograhpy (CT) or Magnetic Resonance Imaging (MRI) scanning is used. In previous studies that use routine additional CT or MRI imaging, high rates of cPRF’s are found ranging between (59%-96,8%). Previous studies advise routine pelvic CT-scanning for every patient with pubic rami fractures because of the high cPRF detection rate and is considered standard therapy. However, the clinical consequences of this routine CT-imaging have not yet been established. Because of this lack of knowledge, incomplete evidence based protocols exist for FFP’s. Further studies are needed to establish the additional clinical value of routine CT imaging in fragility fractures in order to establish definitive evidence based diagnostic and treatment schemes. This study will establish the additional clinical value of routine imaging in FFP patients sustaining a low energy trauma by studying the number of treatment alterations due to the pelvic CT-scan by taking questionnaires with the treating trauma- or orthopedic consultant with regards to the treatment pre- and post CT-scan and questionnaires for the patients with regards to pain, quality of life and mobilization ability over time.

Routine CT-scanning of the pelvis in (suspected) ramus inferior/superior fractures in the elderly will lead to significant alternations of treatment strategies with regards to the number of patients receiving operative treatment, a more restrictive ambulation policy in the post-trauma period, hospital admission and/or more intensive outpatient clinical follow-up.

Day one, seven, 28 and 90 post after trauma

No interventions with regards to patient care will be performed in this study. Outcome will be measured via questionnaires that are completed by treating physicians and patients.