Presentation
Car accident. (Hot Read)
Patient Data
Bilateral superior and inferior pubic rami fractures and right sacral ala fracture. Normal SI joint and pubic symphysis alignment. Several sharp foreign bodies with appearance and density consistent with glass are projected near the left hip.
Bilateral superior and inferior pubic rami fractures and right sacral ala fracture. The fragments of glass on the pelvic radiograph are shown to be external to the patient. Note the sizable pre-sacral hematoma. Hemorrhage in this location should always prompt a search for a sacral fracture. In this case the fracture is obvious, however in many cases the fracture can be subtle and the hemorrhage may help alert the reader to look closer.
Case Discussion
Pubic rami and right sacral ala fractures. On the CT a pre-sacral hematoma is seen without active bleeding. Hemorrhage in this location is easy to detect (even a trace amount) and is a high yield check area in trauma imaging. If haemrrohage is present, then this should always prompt a search for a sacral fracture. In this case the fracture is obvious, however in many cases the fracture can be subtle and the hemorrhage may help alert the reader to take look closer.
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