Pelvic Lines

ED history: Trauma 

Real history: 60 yo female struck by car in parking lot and subsequently run over. 

Fractures? Gonna need The Count from Sesame street to help us with this one.  Let's start with the newer teaching point and then we'll hit the refresh button:

Shenton line:

You'll maybe recognize this from your pediatric Developmental Dysplasia of the Hip (DDH) learning bites (I know my lane; talk to your local friendly Peds Rad if you want details).  

In trauma, this line is a reliable quick check of the femoral neck.  The femoral portion of the line should be a continuous, unbuckled, undisrupted curvilinear course from the bottom of the femoral head all the way into the medial diaphysis (ignore the lesser trochanter, everyone else does)

How's this play out on our Pelvis XR in question?

Nice.  Got one fracture done, but what's that at the blue arrow?  An inferior pubic ramus fracture? Is that part of a ring structure? Where should I look next?

It's been a while. Anyone remember the Iliopubic (iliopectineal) line during our acetabulum convo?  

So fresh and clean on the right.  Appreciate those little juts and jags on the left (blue arrows). Easy to miss if the inferior ramus hadn't been displaced.  Feels good to find something subtle....

....hey...but didn't we learn something about pelvic RING injuries that if something is broke up front, something is broke out back too.  Shall we look?

Trashed.  Always check the top 2 sacral neuroforaminal arches and make sure they're smooth (as demonstrated on the left) and not bent, buckled, or raggedy (as demonstrated on the right). Appreciate the right SI joint looks widened too.  With our pubic symphysis looking good, this is a Lateral Compression pattern pelvic ring injury.

Recap:

Use the Shenton Line to check your femoral neck (it's not just for the kids!).

Always check your Rings!

      - Pubic rami and symphysis up front (continue through the ilioischial and iliopubic lines). 

      - Sacral arches and SI joints out back. 

Remember that when you've found 1 fracture, it' doesn't mean you're done counting!

Some Articles Below!

Shenton Line: https://radiopaedia.org/articles/shenton-line?lang=us

Pelvic Fractures: https://radiopaedia.org/articles/pelvic-fractures?lang=us