Pelvic Fractures

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definition/description

A pelvic fracture is a disruption of the bony structures of the pelvis. The pelvis consists of the ilium, ischium and pubis. These form an anatomic ring with the sacrum. Disruption of the ring requires a lot of energy. Because in most of the cases pelvic fractures are caused by high impact, it is possible that organs in the bony pelvis are affected. Trauma to extra-pelvic organs is common. They are often associated with severe hemorrhage due to the extensive blood supply to the region. Pelvic fractures are associated with a high morbidity and mortality. Emergency care with primary aim reducing blood loss is always necessary.

There are two classification systems who are used most commonly to describe pelvic fractures:
Classification of pelvic fractures by Tile is based on the integrity of the posterior sacroiliac complex.
• Type A: rotationally and vertically stable, the sacroiliac complex is intact. Mostly managed nonoperatively.
o A1: avulsion fractures
o A2: stable iliac wing fractures or minimally displaced pelvic ring fractures
o A3: transverse sacral or coccyx fractures
• Type B: rotationally unstable and vertically stable, caused by external or internal rotational forces, results in partial disruption of the posterior sacroiliac complex.
o B1: open-book injuries
o B2: LC injuries
o B3: bilateral type B injuries
• Type C: rotationally unstable and vertically unstable, complete disruption of the posterior sacroiliac complex, result of great force.
o C1: unilateral injury
o C2: bilateral injuries in which one side is a type B and the controlateral side is a type C injury
o C3: bilateral injury in which both sides are type C injuries

Classification of pelvic fractures by Young and Burgess is based on mechanism of injury: lateral compression, anteroposterior compression, vertical shear or a combination of forces.
• Grade I: associated sacral compression on side of impact. Associated widening of pubic symphysis or of the anterior sacroiliac joint, while ligaments remain intact.
• Grade II: associated posterior iliac fracture on side of impact. Associated widening of the anterior SI joint caused by disruption of the anterior SI, sacrotuberous and sacrospinous ligaments, posterior ligaments remain intact.
• Grade III: associated controlateral sacroiliac joint injury. Complete SI joint disruption with lateral displacement and disrupted anterior SI, sacrotuberous, sacrospinous and posterior SI ligaments.

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