Presentation
MVA. Tubed at the scene.
Patient Data
Pelvic binder noted. Comminuted displaced fractures of the bilateral superior and inferior pubic rami, more displaced on the left. The pubic symphysis however maintains normal width.
No widening of the sacroiliac joints. Loss of the normal right sacral anterior foraminal lines suggests a right sacral fracture. Hip joints are normally located. CT advised.
Obliquely oriented comminuted fracture of the right sacral ala with involvement of the sacroiliac joint anteriorly without significant diastasis. The fracture extends distally and involves the right S1-S3 neural foramina. Surrounding hematoma noted. Also swollen right piriformis muscle indicating intramuscular hematoma. No focal contrast blush.
There also comminuted and displaced fractures of bilateral inferior and superior pubic rami. Minor right pelvic side wall hematoma from the pubic fractures.
Case Discussion
Loss of the 'seagull' curvilinear lines on the anterior aspect of the sacral is a sign of sacral fracture.
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