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Lateral Compression Injuries

- See: Pelvic Fractures

- Discussion:
    - most common form of pelvic fracture;
    - transverse frx of pubic rami & ipsilateral / contralateral to posterior injury;
    - LC injuries are described by both their anterior and posterior pathology;
    - pelvic ring implodes or collapses, & one side rotates medially toward and occassionally beyond midline (side of impact),
            usually on a posteriorly based perpendicular axis;
            - often these have rotational instability, with verticle stability;
            - usually the sacrotuberous and sacrospinous ligaments are intact;
    - transverse frx of at least one set of pubic rami;
            - subsets: of anterior ring;
                    - unilateral pubic rami frx (superior and inferior);
                    - unilateral rami frx w/ symphysis injury;
                    - bilateral rami frx (all 4 rami frx'ed)
                    - bilateral rami frx with pubic symphysis injury; 
                    - displaced superior ramus fracture = tilt fracture

    - associated injuries
            - most common identifiable cause of death in patients with lateral compression fractures is closed head injury
            - vascular injuries:
                     - occassionally LC frx may  result in major hemorrhage if one of fracture fragments directly tears one of the larger
                             vessels of the pelvis;

- Classification:
    - LC-I
           - sacral compression frx on side of impact;
           - least destructive lateral compression injury;
           - not unstable, because even sacral frx is impacted;
           - stable lateral compression injury, in which tension bands are intact;
           - references:
                  - Validated Radiographic Scoring System for Lateral Compression Type 1(LC-1) Pelvis Fractures.
                  - What constitutes a Young and Burgess lateral compression-I (OTA 61-B2) pelvic ring disruption? A description of computed tomography-based fracture anatomy and associated injuries.
                  - Operative agreement on lateral compression-1 pelvis fractures. a survey of 111 OTA members.
    - LC-II
           - crescent (iliac wing) frx on side of impact;
           - w/ increasing lateral force, usually imparted to anterior pelvis, major frx frag is rotated inward, w/ anterior sacrum
                     acting as pivot;
           - this gives rise to either a portion of iliac wing to hinge outwards, or to an oblique fracture of posterior ileum, usually
                     extending laterally from sacroiliac joint;
           - ref: Does Surgical Stabilization of Lateral Compression-type Pelvic Ring Fractures Decrease Patients' Pain, Reduce Narcotic Use, and Improve Mobilization?

    - LC-III
           - LC-1 or LC-II injury on side of impact + contra-lateral APC injury;
           - most severe form of lateral compression is severely unstable;
           - lateral compressive force on one side of pelvis continues to contralateral side where it becomes distracting force, externally
                     rotating anterior pelvis; 

- Management:
    - in lateral compression injuries the pelvis is pushed inward;
           - consequently, the instability is in internal rotation.
    - to overcome this, the hemipelvis must be placed in external rotation;
           - in a stable lateral compression injury, in which tension bands are intact, it is unlikely that the reduction will be overcorrected;
    - in some cases, the fracture reduces in the supine position;
    - in some cases, the reduction can be held with a K wire across the symphysis, which holds it in position for 6-8 weeks;
    - in other cases, a external fixator is required to distract open the pelvic wings;
           - when using an external fixator for LC injuries, use flouro to monitor the effect that anterior distraction has on posterior
                  compression injury;
                  - if the posterior injury becomes disimpacted, the injury may become unstable;
    - in the report by Bellabarba C, et al (2000), the authors report on 14 consectutive vertically stable lateral compression frxs;
           - these patients underwent closed reduction and maintenance of the distraction force with a two pin single bar external fixator
                  (supra-acetabular external fixator) followed by immediate wt bearing;
           - pins were inserted directly through the anterior inferior spines;
           - the authors note that all fourteen patients achieved a symmetric reduction;
           - time to healing was about two months;
           - there were no neurologic injuries occuring from the reduction
           - ref: Distraction external fixation in lateral compression pelvic fractures..

Fixation Strategy Using Sequential Intraoperative Examination Under Anesthesia for Unstable Lateral Compression Pelvic Ring Injuries Reliably Predicts Union with Minimal Displacement.

Lateral compression fractures of the pelvis: the importance of plain radiographs in the diagnosis and surgical management.

The Unstable Pelvic Fracture: Operative Treatment

Distraction External Fixation in Lateral Compression Pelvic Fractures.

Young and Burgess Type I Lateral Compression Pelvis Fractures: A Comparison of Anterior and Posterior Pelvic Ring Injuries 

Persistent Impairment After Surgically Treated Lateral Compression Pelvic Injury

What Are the Patterns of Injury and Displacement Seen in Lateral Compression Pelvic Fractures?

Nonoperative immediate weightbearing of minimally displaced lateral compression sacral fractures does not result in displacement.