Pelvic + acetabular fractures

Young Burgess system

Young-Burgess system criteria	Definition
AP component	vertical fractures of pubic rami  → hemipelvic bones separated
Lateral compression	Horizontal pubic rami fractures/ locked symphysis
Vertical shear	1 hemipelvis displaced vertically  → pubic symphysis separation/ vertical pubic rami fractures  → SI region disrupted → severely unstable + soft tissue tearing

Causes of AP component

Car vs pedestrian  MB vs pole

Causes of Lateral compression

Side on road accident  Fall from height to side

Vertical shear causes

Fall from height onto 1 leg

AP subclassification

	APC I	APC II	APC III
Pubic diastasis	< 2.5 cm	> 2.5 cm	> 2.5 cm
Posterior ligament	Intact	disrupted	disrupted
SIJ ligament	Intact	Intact	disrupted
Stability	Y	Vertical: Y Rotation: N	Vertical: N  Rotation: N

Lateral compression sub classification

	LC I	LC II	LC III
Impaction	Ipsilateral anterior sacral
Fracture	Ipsilateral horizontal pubic rami	Ipsilateral horizontal pubic rami + ipsilateral fracture of iliac wing
Posterior ligament	Intact	Disrupted	Disrupted
Stability	Y	Vertical: Y Rotation: N	Vertical + rotation: N
Others	/	/	APC contralateral injuries + externally rotated

Classification of pelvic fractures based on stability

Bucholz/ TIle/ AO or OTA classification system

Acetabular MOI + classification

MOI	Injury caused
Direct lateral impact ( fall from height)	Neutral hip: transverse fracture  Hip ER + abd: anterior column fracture  Hip IR + add: posterior column fracture
Impact anteriorly through knee	Posterior column injury  → more knee flexion → more inferior impact

Letournel system: simple + complex: combination of simple fractures

Medical management of stable pelvic fractures

Non-operative  WBAT  Analgesia  Pelvic binder → APC I

Medical management of unstable pelvic fractures

Operation:  aim for reduction + stable pelvis + prevent deformity + avoid non-union Examples: Anterior external fixation Anterior internal fixation Posterior internal fixation Infixes   Traction: X early mobilisation → when pt X operative fixture

Medical management of Acetabular fractures

Non-op: 

→ NWB/ TWB

Examples: skeletal longitudinal traction +/- lateral traction  

Op: 

examples: 

1. ORIF: elderly + much displacement

If the characteristics predicts early post traumatic arthritis/ femoral head injury/ unattainable reduction: ORIF + THA 

2. Delayed THA: bc failed ORIF/ progressive OA after conservative Mx

3. Acitve THR

Physio Mx of stable pelvic fractures

Systems maintenance  Bridge + block rolling education  WBAT while mobilisation in time w/ analgesia  Address balance deficits  Progress w/ hip + knee strength exercises when pain drops + mobility improves  Rehab vs DC from ward → only when independent mobilisation

Physio Mx unstable fractures pelvis

1. RIB first 48 hrs 

2. 6-8/ 52 TWB

3. 6/52 WBAT

Skeletal traction: 

1. Maintenance for UL + LL 

2. Hip ROM exercises 

3. Split bed Mx → knee F/E + quad strengthening

Fixation: 

1. Variable 

2. Increase sitting time to prep for mobilisation → progression 

3. Hip + knee F to pelvic tilt provided fixation is satisfactory 

4. Doctor’s orders split bed technique +/- bridging

Physio Mx of acetabular fractures

Non- op

1. Hip ROM maintenance 

2. Systems maintenance 

3. Active assisted hip + knee exercises 

4. PWB for 6/52 after traction 

Op: 

ORIF: 

1.  limit WB as per doctor’s orders

2. Graded strengthening exercise 

3. System maintenance