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Review Question - QID 8221

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QID 8221 (Type "8221" in App Search)
A 37-year-old man is evaluated in the emergency department after a motor vehicle accident at 40 mph. He reports low back and buttock pain and numbness in his perineum. After initial radiographic evaluation of his pelvis, he is advised to attempt weight bearing but is unable to because of severe pain. A CT scan of the pelvis is ordered. The radiographs and CT scan are shown in Figures 81a through 81d. What study should be obtained next?
  • A
  • B
  • C
  • D

CT scan of the abdomen

11%

5/44

Judet views of the pelvis

9%

4/44

MRI scan of the lumbar spine

45%

20/44

Lateral radiograph of the sacrum

30%

13/44

Electromyography of the lumbosacral plexus

5%

2/44

  • A
  • B
  • C
  • D

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The patient has a U-type fracture of the sacrum. The best way to visualize this fracture is with a lateral view of the sacrum or sagittal reformatted images of the CT scan. Standard pelvic radiographs often miss this injury. A high index of suspicion must be maintained for a transverse fracture component (H- or U-type fracture) in a patient with bilateral sacral injuries, especially without any anterior pelvic ring fractures. This injury occurs by a different mechanism than pelvic ring disruptions, thus the sacrum will fracture oftentimes without associated anterior pelvic injuries. These injuries have a high rate of associated neurologic injury. Treatment of these injuries varies based on neurologic compromise and displacement.

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