Presentation
Multiple injuries following a motor vehicle collision traveling approximately 35 mph with head-on collision. Airbags were deployed. No loss of consciousness and the patient is hemodynamically stable.
Patient Data
AP, inlet, and outlet radiographs of the pelvis demonstrate bilateral iliac wing fractures, with greater comminution and displacement on the right. There is displacement of the right anterior superior iliac spine. Contrast and catheter are seen in the urinary bladder.
CT of the pelvis confirms bilateral iliac wing fractures, with greater comminution and displacement on the right. There is displacement of the right anterior superior iliac spine. The fractures do not extend to the acetabula. There is enlargement of the right iliacus and right gluteal musculature around the right iliac wing fracture, consistent with hematoma. However, no contrast extravasation is seen to suggest an active arterial bleed. There is also subcutaneous hemorrhage/contusion overlying the bilateral iliac wings. This CT was reconstructed from a CT of the chest, abdomen, and pelvis with IV contrast. There is contrast in the urinary bladder from a prior CT performed at an outside institution.
Case Discussion
Duverney fractures are typically isolated iliac wing fractures caused by a direct blow to the iliac wing. They often occur during motor vehicle collisions, as in the case above. The fracture is usually isolated, and there is no structural damage outside of the iliac wing. Imaging is performed to evaluate the extent of the fracture and to ensure that no adjacent structures have been injured.
This case is unique as the patient had bilateral Duverney fractures from a single accident. While these fractures occurred in non-weight-bearing locations, the patient's advanced age and the presence of bilateral fractures might delay the normal recovery process.
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