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Categorias
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LC
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Lateral compression
Lateral compression: a side-directed force that internally rotates the hemipelvis, typically producing a transverse/oblique anterior ring fracture with an ipsilateral posterior (sacral) injury; the most common mechanism and generally the more stable pattern (subtypes LC1 anterior sacral compression, LC2 crescent fracture, LC3 contralateral AP injury).
CondutaLC1 is typically stable and managed non-operatively; LC2 and LC3 are unstable and generally require fixation. Use caution with pelvic binders, which can over-compress an internally rotated (LC) pelvis and injure other structures.
RiscoGenerally the more stable, lower-hemorrhage pattern; closed head injury (not pelvic bleeding) is the most common cause of death in LC injuries. Stable patterns carry ~7.9% mortality versus ~11.5% for unstable patterns.
verificadoPelvic ring disruptions: mechanism of injury classification (Young and Burgess)Evaluation > Classification (Young and Burgess classification); Treatment/Prognosis (LC1 stable/non-operative, LC2-3 unstable; binder over-compression caution; head injury leading cause of LC mortality; ~7.9% vs ~11.5% mortality stable vs unstable)
APC
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Anteroposterior compression
Anteroposterior compression: a front-to-back force that externally rotates the hemipelvis, opening the symphysis (open-book pattern) with progressive disruption of the sacrospinous, sacrotuberous, and sacroiliac ligaments; associated with hemorrhage (APC1 minor symphysis widening, APC2 >2.5 cm opening with anterior SI ligament disruption, APC3 complete anterior and posterior SI disruption).
CondutaAPC1 is minimally unstable; APC2 and APC3 are progressively unstable and require fixation. A pelvic binder can help reduce open-book volume acutely; angioembolization is considered for ongoing arterial bleeding.
RiscoHigher hemorrhage risk; the superior gluteal artery is most frequently injured in APC patterns. Unstable patterns carry higher mortality (~11.5%) than stable ones (~7.9%).
Vertical shear: an axially directed force producing vertical displacement of the hemipelvis with complete ligamentous disruption, representing complete (rotational and vertical) instability.
CondutaCompletely unstable; requires operative stabilization, with a pelvic binder considered in the hemodynamically unstable patient for temporary stabilization.
RiscoComplete instability with high associated hemorrhage and injury burden; falls in the unstable group with the higher (~11.5%) mortality.
Combined mechanism: any combination of the lateral compression, anteroposterior compression, and vertical shear force patterns.
CondutaNo distinct treatment pathway; managed according to its component patterns (stability, fixation, and resuscitation needs of the dominant injuries).
RiscoRisk reflects the component patterns; unstable combinations align with the higher (~11.5%) mortality of unstable pelvic ring injuries.