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This retrospective study compared plain radiographs to CT scan for the detection of pelvic fractures in patients over 65 years of age. The authors concluded “Pelvic radiographs have low sensitivity in detecting traumatic pelvic fractures. These radiographically occult fractures may be clinically significant as a cause of long-term pain and may require orthopedic consultation and possible surgical management.”
If you have a high clinical suspicion due to pain or inability to ambulate, CT may be warranted if the X-Ray is negative.
References
Ma, Y., Mandell, J.C., Rocha, T. et al. Diagnostic accuracy of pelvic radiographs for the detection of traumatic pelvic fractures in the elderly. Emerg Radiol (2022). https://doi.org/10.1007/s10140-022-02090-w