From the Guidelines
Pelvic ring fractures are classified based on CT scans using the Young-Burgess classification system, which categorizes injuries according to the mechanism of injury and resulting instability patterns. This system divides pelvic fractures into four main types: lateral compression (LC), anteroposterior compression (APC), vertical shear (VS), and combined mechanism (CM) injuries. Each type is further subdivided based on severity. Lateral compression injuries (types I-III) involve varying degrees of sacral compression and pubic rami fractures. Anteroposterior compression injuries (types I-III) range from minor pubic diastasis to complete disruption of anterior and posterior ligaments. Vertical shear injuries involve complete disruption with vertical displacement of hemipelvis. CT scans are essential for this classification as they provide detailed visualization of both anterior and posterior elements of the pelvic ring, allowing assessment of sacroiliac joint disruption, sacral fractures, and pubic symphysis widening that may not be visible on plain radiographs. This classification system guides treatment decisions, with higher grades generally requiring more aggressive intervention including surgical fixation, as supported by the World Journal of Emergency Surgery 1.
Some key points to consider in the classification and management of pelvic ring fractures include:
- The use of CT scans with 3-Dimensional bones reconstructions to reduce tissue damage and risk of neurological disorders after surgical fixation 1
- The importance of early diagnostic workup with multi-phasic CT-scan with intravenous contrast to exclude pelvic hemorrhage in patients with pelvic trauma associated with hemodynamic normality or stability 1
- The recommendation for retrograde urethrogram or/and urethrocystogram with contrast CT-scan in presence of local perineal clinical hematoma and pelvic disruption at Pelvic X-ray 1
- The need for perineal and a rectal digital examination in case of high suspicious of rectal injuries, and proctoscopy in case of a positive rectal examination 1
The Young-Burgess classification system is a widely accepted and useful tool for classifying pelvic ring fractures, and its use can help guide treatment decisions and improve patient outcomes, as noted in the World Journal of Emergency Surgery 1.
From the Research
Classification of Pelvic Ring Fractures
The classification of pelvic ring fractures based on computed tomography (CT) scans is a complex process that involves understanding the anatomy of the injury, predicting prognosis, and defining treatment. Several classification systems have been developed, including the Young-Burgess and Tile classification systems.
Classification Systems
- The Young-Burgess classification system distinguishes between anteroposterior compression, lateral compression, and vertical shear fractures 2.
- The Tile classification system distinguishes between type A (stable), type B (rotationally unstable), and type C (completely unstable) fractures 2, 3.
- The AO/OTA classification system is also used to classify pelvic ring fractures 2.
Imaging Modalities
- CT scans have superior sensitivity and specificity compared to plain pelvis x-rays and are considered the "diagnostic workhorse" for pelvic ring fractures 2.
- MRI is useful for showing bone marrow edema, cauda and plexus complications, and peripelvic soft tissue damage, and may be particularly important in fragile pelvic fractures 2.
- Other imaging modalities, such as angiography, ultrasonography, and bone scintigraphy, may also be used to diagnose and treat pelvic ring fractures 2.
Interobserver Variability
- Studies have shown that there is a moderate degree of agreement among orthopedic trauma surgeons when using the Young-Burgess and Tile classification systems 4, 5.
- Intraobserver agreement has been found to be substantial for the Young-Burgess classification and moderate for the Tile classification 5.
- The degree of inter- and intraobserver variability may limit the usefulness of these classification systems, both clinically and for research purposes 4, 5.