- See: Pelvic Fractures
- 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;
- 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;
- 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.
- 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-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;
- 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
- 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.