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Demographics:
18 years old, Female
Indication:
Trauma
Findings
- Acute mildly displaced fractures of the left superior and inferior pubic rami
- Acute minimally displaced fracture of the left sacral ala with offset of several left sacral arcuate lines
- Foley catheter in place with contrast material in the urinary bladder
- Bladder is displaced to the right
Diagnosis
Stable pelvic ring injury (LC I)
Sample Report
Acute mildly displaced fractures of the left superior and inferior pubic rami.
Acute minimally displaced fracture of the left sacral ala.
No diastasis of the pubic symphysis or sacroiliac joints.
Joint spaces are maintained.
Rightward displacement of the bladder raises concern for a left pelvic hematoma.
Discussion
- It is important to be able to recognize unstable pelvic injuries because this impacts immediate patient management (pelvic binders are typically placed before the patient even goes for CT imaging)
- The Young Burgess classification is the most commonly used system:
- Anterior-posterior compression (APC) - the pubic symphysis is the weak link, so it is affected first
- APC I: widening of the pubic symphysis < 2.5 cm
- Stable
- APC II: widening of the pubic symphysis > 2.5 cm, anterior sacroiliac joint widening
- Vertically stable, rotationally unstable
- APC III: widening of the pubic symphysis > 5 cm, widening of anterior and posterior sacroiliacs joints
- Globally unstable
- APC I: widening of the pubic symphysis < 2.5 cm
- Lateral compression - the obturator ring is the weak link, so it is affected first
- LC I: obturator ring fractures and sacral compression fractures
- Stable
- LC II: LC I + iliac crescent fracture
- Vertically stable, rotationally unstable
- LC III: LC I/II with a contralateral APC injury
- Globally unstable
- LC I: obturator ring fractures and sacral compression fractures
- Vertical shear - Vertical hemipelvis translation with offset of the pubic symphysis and sacroiliac joint
- Globally unstable
- Anterior-posterior compression (APC) - the pubic symphysis is the weak link, so it is affected first
Annotated Images & Illustrations
Stable pelvic ring injury (LC I) with left obturator ring fractures (red arrows) and left sacral fracture with slight offset of the left sacral ala (yellow arrow) and several arcuate lines (blue arrows).