Pelvic fractures: value of plain radiography in early assessment and management.

Abstract

Assessment of pelvic fractures in severely traumatized, clinically unstable patients presents a diagnostic problem. Traditional plain-radiographic classifications of the fracture are of limited preoperative value to the surgeon who must apply corrective force in opposition to the original force vector causing the fracture. Computed tomographic scanning is an effective method of examining the pelvis but is time consuming and may be impractical in cases of severe injury. In a retrospective analysis of the plain radiographs of 142 cases of pelvic fracture, four patterns of force were identified, presenting distinctive, recognizable radiographic appearances. These patterns are anteroposterior compression, lateral compression, vertical shear, and a complex pattern. The resulting classification of pelvic fracture, based on radiographic and clinical findings, correlates with associated injury to soft-tissue structures and enables the surgeon to begin corrective procedures rapidly.

Classifications in Brief: Young and Burgess Classification of Pelvic Ring Injuries

“…Additionally, by recognizing vertical shear injuries, traction can be applied to reduce the proximally displaced hemipelvis. These concepts were articulated by Young et al [27] and continue to be a cornerstone in the evaluation and treatment of patients with pelvic ring injuries.…”

“…Tile et al [23] added the concept of stability (ie, stable, vertically stable but rotationally unstable, vertically and rotationally unstable). Acetabular fractures were considered separately in the classifications of Tile et al (comprehensive classification) [23] and Young et al (Young and Burgess classification) [27].…”

“…In 1986, Young et al described 142 patients with pelvic ring injuries and classified their injuries mechanistically [27] (Fig. 1).…”

“…AP-directed forces cause deformity or instability in a predictable pattern based on the injury and disruption of anterior and posterior pelvic structures. Originally, Bucholz [1] evaluated AP injuries and classified them in three types based on the extent of injury to the posterior pelvic elements and this concept was applied to the Young and Burgess classification [27].…”

Preperitoneal Pelvic Packing: How and When

“…We prefer to use the Young and Burgess classification system, which classifies injuries by mechanism-vertical shear in the presence of vertical displacement, anterior-posterior compression with significant pubic symphyseal diastasis (APC I, II, III depending on degree of sacroiliac dislocation) or lateral compression fractures (LC I, II, III depending on disruption of contralateral elements and/or iliac wing fracture) [13,14]. There have been several retrospective studies that have shown an association between pelvic fracture classification and risk of arterial injury and/or the need for transfusions [15•, 16].…”