Pelvic Disruption: Assessment and Classification

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Number 151September, 1980 Pelvic Disruption Assessment 17nL 1;1FIGS. 7A and 7B. (Left) Diagram of a typical anteroposterior compression fracture (open-book type)showing a disruption of the symphysis pubis and the anterior sacroiliac ligaments. (Right) Radiographof a patient with this typical injury. The arrows indicate the widened sacroiliac joint anteriorly.some degree of flexion of the hip joints(Fig. 8).LATERAL COMPRESSIONThe greatest number of fractures of thepelvis occur from lateral compressive forces.Most are caused by simple falls and arerelatively undisplaced when first seen.Several types of lateral compressioninjury are identified (Table 1). As in theanteroposterior compression injury, theanterior disruption may be through thesacrum, sacroiliac joint or ilium. The patterns,however, are vastly different fromthose produced by anteroposterior compressionand are marked by inward rotationof the hemipelvis. The lateral compressionforce may crush the sacrum anteriorly,leaving the posterior sacroiliac ligamentsintact. In these cases, the pelvis remainsstable and management is uncomplicated.In some cases, however, continuation of thelateral compression force ruptures theposterior sacroiliac ligaments, renderingthe pelvis unstable (Fig. 6).pelvis rotates inward. Usually the rami onthe site of impact break, and as the forcecontinues medially, the anterior sacrum iscrushed, (Figs. 9A and 9B). In some cases,continuation of the compressive force willrupture the posterior sacroiliac and iliolumbarligaments and render the hemipelvisunstable (Fig. 6). When the patient arrivessupine in the X-ray department, spontane-
18 Pennal, et al.Clinical Orthopaedicsand Related ResearchFIGS. 9A and 9B. (Left) Diagram of a lateral compression injury, ipsilateral type, showing aposteriorfracture and the anterior disruption of the pubic rami with internal rotation of the hemipelvis. (Right)Radiograph of a typical lateral compression injury.ous reduction may have occurred and theposterior injury may be difficult to diagnose.The potential instability of an apparentlyinnocent fracture is often unrecognized.The use of a sling in this situation increasesthe deformity, and is therefore, contraindicated.Figures 10A and 10B show anexample of the degree of instability withthe sling in place. Persistence of this methodof treatment may cause a malrotation ofthe pelvis and permanent disability tothe bladder.Type B: Contralutrrml (bucket-handle).When a lateral compressive force combinedwith an upward rotatory component occurs,the fracture pattern is surprisingly constantwith fractures of both pubic rami on the sideopposite the impact, and fracture in thesacroiliac area posteriorly on the side ofimpact (Figs. 11A and 11B). The resultantFIGS. 10A and 10B. (Left) The use of a pelvic sling increases the deformity by lateral compression.(Right) X-ray indicating displacement secondary to use of a sling.
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Pelvic Disruption: Assessment and Classification

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