Anterior-Posterior
Compression of the pelvis in an AP orientation causes rotation of the pelvis resulting in what we commonly refer to as an "open book" fracture. You will notice disruption at the pubic symphysis as well as the SI joints. Occasionally you can see sacral or iliac fractures with this type of injury.
Lateral
Compression in the lateral direction causes various injuries, usually isolated to the side of the pelvis which absorbs the impact. Common mechanism for this type of fracture includes pedestrians struck by autos. These fractures are usually associated with less blood loss than AP injuries.
Vertical Shear
Compression from an axial load will result in a vertical shear injury. Axial loads are sustained from fall from height or even slipping underneath the dashboard in an MVC. This is the most unstable of the three classifications and can result in the most blood loss. In addition to injuries to the pelvic ring, be on the lookout for injuries to the lower sacrum, avulsion of the ischial spine as well as the fifth lumbar transverse process.
Young and Burgess described these classifications in detail. Here is an illustration which helps to visualize the classification system:
Why is it important to classify these injuries? The management is not the same. For example: placing a pelvic binder on a vertical shear injury could create more injury. Ultimately- approach all pelvic trauma as you would any pt with potential for massive hemorrhage- large bore IVs, fluids followed by blood products. Maintain a high index of suspicion for other significant injury such as bladder, urethra and other vascular injuries.
References:
Rosen's Emergency Medicine
Seventh Edition
Chapter 52, Pelvic Trauma
Burgess AR, Eastridge BJ, Young JW, et al: Pelvic ring disruptions: Effective classification system and treatment protocols. J Trauma 30:848, 1990
from Dr. Lauren Gallagher
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