Young-Burgess Classification for Pelvic Ring Injuries

Question 1

Symphysis disruption leads to what instability

Answer 1

Can get up to 2.5 cm of diastasis, any more than that means that the sacrotuberous and sacrospinous ligaments are disrupted

Question 2

APC-1

Answer 2

Symphysis

Question 3

APC-2

Answer 3

Symphysis >2.5 cm, longitudinal rami fxs, Ant. SI ligaments open, sacrotuberous and sacrospinous ligaments disrupted

Question 4

APC-3

Answer 4

Symphysis >2.5 cm, longitudinal rami fxs, Ant. and Post. SI ligaments disrupted, sacrotuberous and sacrospinous ligaments disrupted, needs a pelvic binder

Question 5

What is a straddle fracture?

Answer 5

Free floating symphysis, >50% have bladder/urethra injury, nondisplaced only need sx care, needs possible laparatomy because of uro injury

Question 6

How to treat APC fxs

Answer 6

Close the diastasis

Question 7

LC-1

Answer 7

Oblique/Transverse rami fx and ipsilateral anterior sacral ala compression fx

Question 8

LC-2

Answer 8

Rami fx and ipsilateral post. ilium fx dislocation (crescent fx)

Question 9

LC-3

Answer 9

LC-2 + contralateral APC (Windswept pelvis)

Question 10

Vertical Shear

Answer 10

Posterior and superior directed force, highest risk of hypovolemic shock

Question 11

MCC of pelvic ring injuries

Answer 11

Lateral Compression mechanism

Question 12

Sacrotuberous and sacrospinous ligaments in LC

Answer 12

Intact

Question 13

Vertical shear fx also called

Answer 13

Malgaigne

Question 14

VS consists of

Answer 14

Disruption of ant. and post. pelvis along with sacrotuberous and sacrospinous ligaments

Question 15

VS mechanism

Answer 15

Typically caused by falls

Question 16

VS initial management

Answer 16

Femoral traction to pull the elevated side into place

Question 17

Inlet view is taken how and what does it show

Answer 17

Beam is turned 45 degrees caudad. Gets a good view of the AP relationships of the pelvis, good for seeing APC injuries. Also good for seeing rotation about the pelvis. Diastasis. Sacrum is seen on end.

Question 18

Outlet view is taken how and what does it show

Answer 18

Emitter is turned 20-45 degrees cephalad. Good view of Vertical changes. Symphysis overlies S2 body.

Question 19

Most common arterial bleeders

Answer 19

Superior gluteal, internal pudendal, obturator, lateral sacral

Question 20

Leading cause of bleeding

Answer 20

Venous

Question 21

Nonop indications

Answer 21

If isolated ant. injuries: WBAT. If ipsi ant/post ring injuries, protected weight bearing

Question 22

Operative indications

Answer 22

Diastasis >2.5 cm!
Both ant & post. SI ligament disurption
Sacral fx >1 cm displacement

Question 23

Ex-fix through what

Answer 23

AIIS or iliac wing (AIIS is biomechanically stronger but less well clinically tolerated)

Question 24

Ex-fix major complication

Answer 24

LFCN injury

Question 25

Vertically unstable patterns with ant./post. dislocations operative tx

Answer 25

Anterior ring int. fixation and perc SI screw is most stable fixation construct

Question 26

Common complications

Answer 26

Life-threatening hemorrhage in APC II, APC III, LC III patterns; urogenital injury, DVT is most common if you dont use DVT ppx

Question 27

What are the unstable fracture types

Answer 27

APC II/III, LC II, LC III, vertical shear, combined mechanism

Question 28

What kind of rami fxs in LC

Answer 28

Horizontal (almost in coronal plane)

Question 29

XRs to get in sacral fxs

Answer 29

AP pelvis, inlet, outlet, and lateral views. Usually get sacral

Question 30

What kind of sacral compression from LC type injuries

Answer 30

Anterior impaction

Question 31

Sacral fx nonop indications

Answer 31

WBAT if fx incomplete (ilium contiguous with the intact sacrum). TTWB if complete fxs.

Question 32

Sacral fx op indications

Answer 32

Displaced >1 cm

Question 33

Sacral fx neurologic risks

Answer 33

Zone II displaced is highest incidence, L5 root usually involved with Zone II. Cauda equina seen with zone III injuries.

Question 34

How do you get a straddle injury

Answer 34

You slip in the bathtub