Classification

There are several classification schemes for pelvic ring injuries, but the Young and Burgess system4 based on mechanism of injury seems to be the most simplistic. Helps to identify risk of hemorrhage and dictate resuscitation in polytraumatized patients, and has four major categories:

• Lateral compression (LC): typically seen in the classic "rollover" motor vehicle accident. Usually composed of oblique anterior ring fractures with an anterior sacral impaction fracture or iliac wing "crescent fractures" posteriorly.5 Usually see internal rotation of one hemipelvis. High incidence of associated traumatic brain injuries and abdominal injuries.

• Anteroposterior compression (APC): usually composed of vertical ramus fractures or pubic symphosis widening ("open book" pelvis). As the injury worsens there is progressive loss of anterior then posterior sacral ligaments with resultant neural and/or vascular damage. Can be associated with very high blood loss. There is an increase incidence of CNS, abdominal, and visceral injury.

• Vertical shear (VS): vertical displacement of one hemipelvis; associated with increased blood loss.

• Combined mechanisms: combined patterns of each of the three types of pelvic ring fractures.

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