Introduction Salter-Harris fractures are fractures that affect the growth plate in skeletally-immature patients. Mnemonic There is a simple mnemonic that is often used to help remember the different types of…
Classification of Pelvic Fractures
The two most common classifications of pelvic fractures are the Tile Classification and the Young-Burgess Classification.
Young and Burgess Classification of Pelvic Fractures
The Young and Burgess classification is based on the direction of forces causing the fracture, severity of the injury and the resultant instability. It is based mostly on the initial A-P radiograph. There are 4 basic categories that pelvic fractures are placed in using Young-Burgess:
- Anterior-posterior compression
- Lateral compression
- Vertical shear
AP Compression Fractures
The anterior-posterior compression fractures result from a direct or an indirect force in an AP direction, causing diastasis of the pubic symphysis, +/- diastasis of the sacro-iliac joint or iliac wing fracture. “Head on” collision.
- APC I: Pubic symphyseal diastasis, <2.5 cm, no significant posterior ring injury (stable).
- APC II: Pubic symphyseal diastasis >2.5 cm, tearing of anterior sacral ligaments (rotationally unstable, vertically stable). Posterior SI ligaments intact. Disruption of sacrospinous and sacrotuberous ligaments.
- APC III: Hemipelvis separation with complete disruption of pubic symphysis and anterior and posterior ligament complexes (completely unstable). Disruption of sacrospinous and sacrotuberous ligaments. Is associated with vascular injury.
Lateral Compression Fractures
Lateral compression fractures result from a laterally directed force causing rotation of the pelvis inwards, leading to fractures in the sacro-iliac joint and the pubic rami. Common characteristic is a transverse ramus fracture.
- LC I: Posterior compression of sacroiliac (SI) joint without ligament disruption (stable). Ipsilateral anterior sacral ala compression fracture.
- LC II: Posterior SI ligament rupture, sacral crush injury or iliac wing fracture (rotationally unstable, vertically stable). Rami fracture and ipsilateral posterior ilium fracture dislocation (crescent fracture).
- LC III: LC II, with open book (APC) injury to contralateral pelvis (completely unstable). Windswept pelvis, common mechanism is MVC rollover.
Vertical Shear Fractures
Vertical shear fractures result from an axial shear force which results in a fracture of the sacro-iliac joint or the ilieum with cepahlic displacement of the fractured component of the pelvis.
- common feature is a vertical fracture of the pubic rami
- displaced fractures of the anterior rami and posterior columns, including SI dislocation (completely unstable)
- associated with the highest risk of hypovolemic shock (63%); mortality rate up to 25%
Combined fractures result from forces that are a combination of those listed above, with a resultant fracture pattern that is a combination or variation of those listed above.
Tile Classification of Pelvic Fractures
- Guthrie HC, Owens RW, Bircher MD. Fractures of the pelvis. J Bone Joint Surg Br. 2010 Nov;92(11):1481-8. doi: 10.1302/0301-620X.92B11.25911. Review. PubMed PMID: 21037339.
- Browner’s Skeletal Trauma: Basic Science, Management, and Reconstruction (5th Edition)
- AO: Fractures of the Pelvis and Acetabulum
- Alton, T. B., & Gee, A. O. (2014). Classifications in Brief: Young and Burgess Classification of Pelvic Ring Injuries. Clinical Orthopaedics and Related Research, 472(8), 2338–2342. http://doi.org/10.1007/s11999-014-3693-8