Pelvic Fractures Types and Management

Join this channel to support the channel : https://www.youtube.com/channel/UCOHfqHMhHvfQCYJDXfpSAiw/join Pelvic Fractures Classification and Management Pelvic fractures. Classification of pelvic fractures. There are two classifications for pelvic fractures. The first one is by Young and Burgess. The second one is by Tile. The purpose of classification is to evaluate the initial X-ray and correlate it with the clinical presentation of the patient in order to determine whether the injury is complex or non-complex. Is it a potentially lethal injury that requires massive transfusion and aggressive resuscitation, or is it a simple injury that allows early mobilization? The Young-Burgess classification is based on the mechanism of injury and pelvic stability. It helps predict transfusion requirements. It includes three types: lateral compression, anteroposterior compression, and vertical shear. Lateral compression represents an internal rotation force applied to the pelvis, which may involve impaction of the iliac ala, with associated transverse or oblique fractures of the pubic rami. The classic example is the crescent fracture, classified as type II. If the force spares the bone, it may disrupt the posterior ligamentous complex. Type I is a minor impaction injury of the ala. Type II is the crescent fracture. Type III is more severe. In type III, there is lateral compression on one side and anteroposterior compression on the other side. In lateral compression types I and II, mortality is usually due to associated head injury. In type III, there is a higher incidence of bowel injury. Anteroposterior compression results from external rotational forces applied to one or both sides of the pelvis, or from forcible abduction of the lower extremities. The pelvis is externally rotated. The symphysis pubis may be widened or the pubic rami may be fractured. In type I, the symphyseal diastasis is less than 2.5 cm. This is a stable injury with intact ligaments and does not require surgical intervention. In type II, the symphysis pubis is widened more than 2.5 cm, with injury to the sacrospinous and sacrotuberous ligaments, and disruption of the anterior sacroiliac ligaments. The pelvis becomes rotationally unstable but remains vertically stable. Vertical instability occurs only when the posterior sacroiliac ligaments are disrupted. In type III, complete disruption of posterior sacroiliac ligaments results in both rotational and vertical instability. Anteroposterior compression type III is associated with the highest transfusion requirements and hemorrhagic shock. Vertical shear injuries involve complete ligamentous disruption and are both rotationally and vertically unstable. These injuries are also associated with significant blood loss. Tile classification is based on stability rather than mechanism and includes types A, B, and C. Type A injuries are stable and include avulsion injuries such as anterior superior iliac spine involving sartorius and anterior inferior iliac spine involving rectus femoris. Iliac wing fractures and transverse sacral fractures are also type A injuries. An avulsion fracture of part of the sacrum may indicate instability, whereas a transverse sacral fracture is considered stable. Type B injuries are rotationally unstable but vertically stable. These include open book injuries with external rotation or lateral compression injuries with internal rotation. Type B2 represents lateral compression injuries with internal rotation due to fractures of the anterior ring on either side, also known as a bucket-handle injury. Type C injuries are both rotationally and vertically unstable. Factors associated with mortality include shock at presentation, need for massive transfusion within the first 24 hours, age greater than 60 years, open pelvic fracture, and high injury severity score. In general, if the leg is externally rotated clinically and the X-ray shows an open book injury, especially type III, the patient may die from hemorrhage. This patient requires a pelvic binder to reduce pelvic volume and control bleeding. It decreases pelvic diameter and minimizes hemorrhage. Resuscitation includes blood, fresh frozen plasma, and platelets in a 1:1:1 ratio. If a patient with lateral compression type I or II deteriorates clinically, evaluate for head injury, as these fractures are not typically associated with major pelvic hemorrhage. These patients do not require a pelvic binder Approximately 90% of bleeding originates from cancellous bone or the pelvic venous plexus. Arterial bleeding occurs in about 10% of cases, Approximately 20% of anteroposterior compression and vertical shear injuries require angiography and embolization, compared to about 2% of lateral compression injuries. Management of unstable pelvic fractures includes restoration of stability with anterior fixation using a multi-hole non-locking plate and posterior fixation with percutaneous sacroiliac screws.