Orthonotes
by the.bonestories
Menu
APC I–III: progressive symphysis/SI disruption (III complete). LC I–III: sacral compression → crescent fx → windswept (bilateral). VS: vertical shear; CM: combined mechanisms.
10 AI-generated high-yield questions by our AI engine
The Young-Burgess classification of pelvic ring fractures, developed by John Young and Alan Burgess in 1987, is a mechanism-based system that classifies pelvic ring injuries according to the direction of the deforming force applied to the pelvis. While the Tile classification grades injuries by stability (based on the posterior SI complex integrity), the Young-Burgess system describes HOW the injury occurred (anteroposterior compression, lateral compression, vertical shear, or combined mechanisms) and links the fracture pattern directly to the mechanism of injury. The Young-Burgess classification is valuable because: (1) it correlates the fracture pattern with the likely haemorrhage risk (different mechanisms produce different pelvic volume changes with different bleeding implications); (2) it helps predict associated injuries based on the mechanism; (3) it guides acute management (particularly the appropriateness of pelvic binder application for specific patterns).
| Pattern | Sub-type | Mechanism | Fracture Description | Tile Equivalent | Haemorrhage Risk |
|---|---|---|---|---|---|
| APC (Anteroposterior Compression) | APC I | Direct anteroposterior compression on the pelvis (head-on collision, crushing injury, pedestrian struck from the front); the pelvis `opens` like a book as the hemipelves rotate externally (external rotation mechanism) | Symphysis diastasis <2.5 cm; the anterior SI ligaments are stretched or partially torn but intact; no posterior ring disruption; the pelvic floor ligaments (sacrospinous, sacrotuberous) are intact | Tile A (symphysis diastasis <2.5 cm) or borderline B1 | LOW |
| APC II | Symphysis diastasis >2.5 cm; anterior SI ligaments TORN; sacrospinous and sacrotuberous ligaments TORN; posterior SI ligaments INTACT → hemipelvis externally rotated but NOT vertically displaced; the `classic open book` injury | Tile B1 (rotationally unstable, vertically stable) | MODERATE-HIGH — pelvic volume is increased by the external rotation of the hemipelvis; venous haemorrhage from presacral plexus; PELVIC BINDER is the immediate management; binder closes the book, reduces volume, tamponades venous bleeding | ||
| APC III | Symphysis diastasis + complete anterior ring disruption + ALL SI ligaments disrupted (anterior + posterior SI + sacrospinous + sacrotuberous); the hemipelvis is completely unstable (rotationally AND vertically); equivalent to a complete SI joint dislocation | Tile C1 (completely unstable) | VERY HIGH — the highest haemorrhage risk of the APC subtypes; both the presacral venous plexus (massive venous haemorrhage from the widely opened pelvic space) and the superior gluteal artery may be torn; pelvic binder + packing + angioembolisation may all be required | ||
| LC (Lateral Compression) | LC I | A lateral force applied to one side of the pelvis (T-bone collision, pedestrian struck from the side, falling onto the side); the hemipelvis rotates internally (medially); the `book is closed` — the pelvic volume DECREASES (unlike APC which opens); the pelvic contents are compressed, not expanded | Horizontal pubic rami fractures (ipsilateral) + ipsilateral sacral ala compression fracture (the sacral ala is compressed/impacted on the side of the direct blow — Zone I sacral fracture); the posterior ring is partially disrupted by the sacral compression but is relatively stable | Tile B2 (rotationally unstable, vertically stable) | LOW-MODERATE — pelvic volume is REDUCED by internal rotation; venous haemorrhage tends to tamponade in the closed space; LC injuries have LOWER haemorrhage risk than APC injuries because the pelvis is compressed (closed) rather than opened |
| LC II | Ipsilateral pubic rami fractures + ipsilateral crescent fracture of the ilium (a fracture through the posterior ilium at the SI joint region — the `crescent` or `sacroiliac fracture-dislocation`); a portion of the posterior ilium remains attached to the sacrum (the crescent fragment) while the anterior ilium rotates internally; the posterior SI ligaments are partially intact (within the crescent fragment) | Tile B2 (partially disrupted posterior ring) | MODERATE — the crescent fracture partially disrupts the posterior ring; higher than LC I but lower than APC II | ||
| LC III (`Windswept pelvis` / Bucket-handle) | The lateral compression on one side is of sufficient energy to push the contralateral hemipelvis outward — creating an ipsilateral LC injury AND a contralateral APC injury (external rotation); the pelvis is `windswept` — one side internally rotated, one side externally rotated; or a `bucket-handle` pattern where the anterior ring fragments rotate in the same direction as the posterior ring disruption on the same side | Tile B3 (bilateral type B injuries) | HIGH — the combined bilateral injury pattern creates significant haemorrhage risk; both the compressed and expanded sides contribute; the windswept pattern is particularly prone to significant blood loss | ||
| VS (Vertical Shear) | VS (single subtype) | Axial loading through one lower extremity (fall from height landing on one foot, or an upward force through the lower extremity); the hemipelvis is driven superiorly relative to the sacrum and the contralateral pelvis; ALL stabilising structures are disrupted (ALL posterior SI ligaments + sacrospinous + sacrotuberous) | The hemipelvis migrates SUPERIORLY on the side of the axial loading; pubic symphysis or rami disruption anteriorly + SI joint or sacral fracture (Zone II/III sacral fracture) posteriorly; limb length discrepancy on the affected side (the hemipelvis has shifted superiorly); the superior migration of the hemipelvis is visible on the AP pelvis X-ray as a stepped iliac crest | Tile C (completely unstable) | VERY HIGH — vertical shear injuries carry the HIGHEST mortality of any pelvic ring injury pattern; ALL posterior stabilisers are disrupted; massive presacral venous plexus haemorrhage + superior gluteal artery injury; the superior migration of the hemipelvis dramatically increases the retroperitoneal pelvic space; bilateral sacral fractures in the VS pattern create `spinopelvic dissociation` |
| CM (Combined Mechanism) | CM | A combination of two or more of the above mechanisms; the fracture pattern cannot be classified as purely one mechanism; typically from complex polytrauma with multiple force vectors | Complex fracture pattern with elements of LC + APC or VS + APC; may be bilateral with different mechanisms on each side | Tile C (usually) | Variable — typically HIGH; the combination of opening (APC) and shear (VS) elements creates significant haemorrhage risk; management follows the principles for the most unstable component |
| Pattern | Binder Appropriateness | Rationale |
|---|---|---|
| APC II/III (open book) | HIGHLY EFFECTIVE — the ideal indication for pelvic binder | Binder closes the `book` — reduces the pelvic volume, approximates the hemipelves, and tamponades venous haemorrhage from the presacral plexus; placed at the greater trochanter level; reduces bleeding by reducing the space for haematoma |
| LC I/II | LIMITED BENEFIT (or may worsen) | The hemipelvis is already internally rotated in an LC injury — further compression with a binder may increase the internal rotation and COMPRESS the fractured hemipelvis further; the pelvic volume is already reduced in LC injuries; a binder provides modest benefit for LC I/II (stabilisation) but does NOT reduce haemorrhage in the same way as for APC; in LC injuries, the haemorrhage tends to self-tamponade because the pelvis is `closed` |
| VS (vertical shear) | PARTIAL BENEFIT (reduces rotation but not vertical translation) | A binder can reduce the rotational component of VS injuries but CANNOT reduce the vertical migration of the hemipelvis; vertical shear injuries require definitive posterior ring fixation (IS screw) for vertical stability; the binder provides temporary rotational stability while the patient is resuscitated and prepared for surgery |
10 AI-generated high-yield questions by our AI engine