Pelvis series

The pelvis series is comprised of an anteroposterior (AP) with additional projections based on indications and pathology. The series is used most in emergency departments during the evaluation of multi-trauma patients due to the complex anatomy the AP projection covers.

The pelvis series examines the main pelvic ring, obturator foramina, sacroiliac joints, symphysis pubis, acetabulum, sacral foramina, and the proximal femur.

The AP pelvis has a diagnostic yield of ~94% in severely injured patients .

See an approach to the pelvic radiograph.

Indications

Pelvic radiographs are performed for a variety of indications including :

• blunt trauma 
• generalized hip pain 
• arthropathy
• post operative follow up after THR 
• Paget's disease 
• fall 

Projections

Standard projections

• AP
  • demonstrates the pelvis in the natural anatomical position
  • arcuate, ilioischial, iliofemoral and Shenton lines  (figure 7-10) are examined against this view

Modified trauma projections

• horizontal beam lateral hip
  • utilized on patients with suspected hip fracture or dislocation
  • demonstrates the neck of femur in the true lateral projection
  • obtained with minimal patient movement
•  Clements-Nakayama view
  • modfied view that requires no lower limb movement and minimum discomfort 
  • used for patients that have suspected bilateral neck of femur fractures or significant bilateral lower limb injuries
  • demonstrates the neck of femur in the true lateral projection
  • utilized on patients with suspected hip fracture or dislocation

Additional projections

• inlet view
  • caudal projection to best demonstrates the main pelvic ring and associated pathology
  • the best view for evaluation of the posterior displacement of both the main pelvic ring and fractures of the pubic symphysis  
• outlet view  
  • a cephalic projection for evaluation of suspected cephalad shift of the hemipelvis 
  • tangential view of the inlet view 
• Judet view (oblique)
  • for evaluation of the superior, medial, lateral, and posterior surfaces of the acetabulum  
• flamingo view
  • evaluation of suspected pubic symphysis instability