Young Burgess Classification: Pelvic Fracture Patterns

Pelvic fractures are serious injuries that can lead to significant complications, including hemorrhage and organ damage. Proper classification is essential for guiding treatment and predicting outcomes. The Young-Burgess classification system categorizes these fractures based on the mechanism of injury and structural damage, helping clinicians assess stability and determine appropriate management.

Main Categories

The Young-Burgess system classifies pelvic fractures according to the direction of force applied during injury. Each type affects structural stability and treatment strategies.

Lateral Compression

Lateral compression (LC) injuries result from side-impact forces, often seen in motor vehicle collisions or pedestrian accidents. These fractures cause internal rotation of the hemipelvis, leading to transverse pubic rami fractures and potential sacral impaction. LC injuries are further divided into three subtypes: LC-I involves sacral compression with minimal displacement, LC-II includes iliac wing or crescent fractures, and LC-III, or “windswept pelvis,” features contralateral external rotation, increasing instability.

Research in The Journal of Orthopaedic Trauma indicates that LC-I fractures are generally stable with a lower risk of hemorrhage, while LC-II and LC-III may require surgical intervention due to greater instability. Early recognition is crucial, as delayed diagnosis can lead to chronic pain and sacroiliac joint dysfunction.

Anteroposterior Compression

Anteroposterior compression (APC) injuries occur from direct frontal or rear impacts, such as high-speed motor vehicle crashes or crush injuries. These forces open the pelvis in an anteroposterior direction, disrupting the pubic symphysis and potentially injuring posterior ligaments. APC fractures are classified into three grades: APC-I involves mild pubic symphysis diastasis with intact posterior ligaments, APC-II features widening of the symphysis with partial sacroiliac disruption, and APC-III includes complete sacroiliac ligament rupture, causing severe instability.

A 2021 study in Injury highlights the high risk of vascular damage in APC-II and APC-III injuries due to disruption of the presacral venous plexus, significantly increasing hemorrhage risk. Immediate application of a pelvic binder and early angiographic embolization are often necessary. Definitive treatment typically involves external fixation or open reduction and internal fixation (ORIF) to restore stability.

Vertical Shear

Vertical shear (VS) fractures result from high-energy axial loading, such as falls from significant heights. These injuries cause vertical displacement of one hemipelvis, disrupting both anterior and posterior pelvic structures, including the sacrospinous and sacrotuberous ligaments. The hallmark radiographic finding is superior migration of the affected hemipelvis, often accompanied by acetabular or femoral fractures.

Research in The Journal of Bone and Joint Surgery indicates that VS fractures carry a high risk of hemorrhage due to vascular injury and are frequently associated with retroperitoneal hematomas. These injuries are highly unstable, requiring urgent stabilization with external fixation followed by ORIF. Long-term outcomes depend on initial displacement and surgical realignment, with potential complications including chronic pain and gait abnormalities.

Combined Patterns

Combined injury patterns occur when multiple force vectors act on the pelvis, creating complex fractures. These injuries often result from high-energy trauma such as vehicular rollovers or industrial accidents. Common combinations include LC with VS or APC with VS, leading to extensive ligamentous and osseous disruption.

A 2020 study in Clinical Orthopaedics and Related Research found that combined pelvic fractures have higher morbidity due to increased instability and associated organ damage. Management requires a multidisciplinary approach involving trauma surgeons, orthopedic specialists, and interventional radiologists. Due to their complexity, individualized treatment plans are essential for optimizing recovery.

Radiographic Indicators

Imaging plays a critical role in diagnosing pelvic fractures and assessing severity. Standard anteroposterior (AP), inlet, and outlet pelvic radiographs provide a comprehensive view of fracture patterns, while computed tomography (CT) scans offer detailed visualization of bony and ligamentous disruptions.

On an AP pelvic radiograph, widening of the pubic symphysis or sacroiliac asymmetry suggests pelvic ring disruption, characteristic of anteroposterior compression injuries. Inlet views highlight transverse displacement by illustrating hemipelvic alignment, while outlet projections emphasize vertical shifts indicative of vertical shear fractures. These projections collectively aid in fracture classification and surgical planning.

CT imaging is essential for evaluating complex fractures and detecting subtle sacral injuries that may be overlooked on plain radiographs. Axial and coronal reconstructions help identify sacral impaction fractures common in lateral compression injuries, while 3D reconstructions provide a spatial understanding of displacement. A 2022 study in Radiology found that CT scans increase diagnostic accuracy by 30% compared to conventional radiographs, particularly for detecting posterior disruptions that affect stability. Contrast-enhanced CT can also assess vascular compromise, identifying active extravasation that may require embolization.

Beyond bony injuries, radiographic findings can reveal soft tissue damage. Retroperitoneal hematomas, visible on CT, often accompany high-energy fractures and correlate with increased hemorrhage risk. Displacement of the bladder or rectum may suggest visceral injury, requiring further evaluation. Recognizing these indicators enables early intervention, reducing complications such as sepsis or multi-organ failure.

Clinical Assessment Factors

Evaluating a pelvic fracture requires a systematic approach that considers both immediate stabilization and long-term function. Initial assessment begins with hemodynamic status, as pelvic fractures often cause significant blood loss. Hypotension without external bleeding raises suspicion for retroperitoneal hemorrhage, necessitating rapid resuscitation and potential hemorrhage control interventions. Clinical signs such as perineal ecchymosis, scrotal hematoma, or an absent distal pulse can indicate vascular injury.

A thorough neurological examination is essential, given the proximity of the sacral plexus to common fracture sites. Sensory deficits in the perineum or lower extremities suggest nerve involvement, which may manifest as foot drop or impaired bladder control. Electromyography and nerve conduction studies can quantify functional impairment, guiding rehabilitation. Open pelvic fractures require urgent surgical debridement due to the heightened risk of infection.

Functional assessment extends beyond acute care to mobility and weight-bearing capacity. Persistent pain or pelvic asymmetry after stabilization may indicate inadequate alignment, increasing the risk of chronic instability. Gait analysis and weight-bearing radiographs help determine if further interventions, such as physical therapy or surgical revision, are needed. Long-term follow-up is particularly important in elderly patients, as pelvic fractures can lead to immobility and complications such as deep vein thrombosis or pressure ulcers.