The Young-Burgess classification system is a widely recognized method for categorizing pelvic fractures, which are breaks in the bony ring that connects the spine to the lower limbs.
The Purpose of Classification
It provides a standardized language, allowing healthcare providers to communicate consistently about specific injury patterns. This ensures all trauma team members understand the patient’s condition. Understanding the injury mechanism aids in guiding the diagnostic process, helping clinicians anticipate additional injuries, such as vascular or neurological damage. The system also helps predict pelvic ring stability, which directly influences treatment planning. It also provides prognostic information regarding patient outcomes.
Understanding the Categories of Injury
The Young-Burgess classification system categorizes pelvic fractures into three types based on the directional force of the injury: Anterior-Posterior Compression (APC), Lateral Compression (LC), and Vertical Shear (VS).
Anterior-Posterior Compression (APC)
APC injuries occur when force is directed from the front to the back of the pelvis, often resulting from a direct blow to the anterior pelvic ring or external rotation of a lower limb. APC type I involves a stable injury with minimal widening of the pubic symphysis, typically less than 2.5 cm. APC type II injuries show greater symphyseal widening, exceeding 2.5 cm, and involve disruption of the anterior sacroiliac joint ligaments, often referred to as an “open book” injury due to the outward rotation of the pelvic halves. The most severe, APC type III, includes complete disruption of both anterior and posterior sacroiliac ligaments, leading to a complete hemipelvis separation and high rates of associated vascular injury.
Lateral Compression (LC)
LC injuries, the most common type, result from a direct lateral impact to the pelvis. LC type I is characterized by stable oblique fractures of the pubic rami and an ipsilateral anterior sacral ala compression fracture. LC type II involves fractures of the pubic rami and a posterior fracture or dislocation of the ipsilateral iliac wing, known as a crescent fracture, making it rotationally unstable but vertically stable. LC type III is the most unstable lateral compression injury, presenting with ipsilateral lateral compression combined with contralateral anteroposterior compression, often described as a “windswept pelvis.”
Vertical Shear (VS)
VS injuries are the most severe and unstable type, resulting from a superiorly directed force to one side of the pelvis, causing vertical displacement of the hemipelvis. These injuries typically involve fractures of the pubic rami and sacroiliac joint dislocations, often with significant ligamentous disruption. Vertical shear injuries are frequently associated with high blood loss and a greater risk of visceral injuries due to the extensive displacement of the pelvic ring. Finally, some pelvic fractures involve a combination of these injury mechanisms, leading to a “Combined Mechanical Injury” (CM) classification, where stability depends on the specific components involved.
How Classification Informs Treatment
For instance, stable injuries like APC type I or LC type I often allow for non-surgical management, focusing on pain control and early mobilization. These injuries typically do not require extensive stabilization beyond external support or bed rest, though careful monitoring for displacement is still required.
Conversely, rotationally unstable injuries, such as APC type II or LC type II, frequently necessitate interventions to restore stability. For APC type II “open book” injuries, external compression devices like a pelvic binder or sheet can help reduce the symphyseal widening and control venous bleeding. Surgical fixation, such as plates and screws, may be considered to stabilize the anterior and posterior pelvic ring, especially if the displacement is significant or if the patient is hemodynamically unstable.
Vertical Shear (VS) injuries, being the most unstable, almost always require aggressive management, often involving surgical stabilization. Skeletal traction may be used as an initial measure to help realign the displaced hemipelvis. Definitive treatment for VS injuries typically involves internal fixation, such as iliosacral screws or plating, to stabilize both the anterior and posterior pelvic ring and prevent further displacement. The classification helps predict the likelihood of complications, such as significant blood loss, which is highest in APC type III and VS injuries, guiding the need for blood transfusions or angiographic embolization.