What's the Diagnosis? By Dr. Michael Tom
Wed, 01/31/2018 - 9:00am
Editor:
A 21 yo M presents to the ED after driving his dirt bike into a telephone pole at high speed. He is alert and oriented, and his only complaint is severe pain in his b/l lower extremities. A portable xray is obtained. What's the diagnosis? (scroll down for answer)
Answer: Anteriorposterior compression injury (open book pelvic fracture)
- Common feature of APC injury is diastasis of the pubic symphysis or longitudinal fracture of the pubic rami
- Account for up to 25% of pelvic fractures/injuries
- Associated with high energy blunt trauma, classically head on MVC
- Classified using the Young Burgess System
- APC I: pubic diastasis < 2.5 cm (stable)
- APC II: pubic diastasis > 2.5 cm, disruption of anterior sacroiliac joint ligaments with intact posterior sacroiliac joint ligaments (rotationally unstable, vertically stable)
- APC III: complete hemipelvis separation- pubic diastasis > 2.5cm, disruption of anteiror and posterior sacroiliac ligaments (unstable)
- Complications include hemorrhage, urogynecologic injury, rectal injury
- Treatment includes application of pelvic binder, resuscitative measures, control of bleeding and early orthopedic consult