What's the Diagnosis? By Dr. Michael Tom

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
  1. APC I: pubic diastasis < 2.5 cm (stable)
  2. APC II: pubic diastasis > 2.5 cm, disruption of anterior sacroiliac joint ligaments with intact posterior sacroiliac joint ligaments (rotationally unstable, vertically stable)
  3. 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