| DESCRIPTION | TREATMENT | |
| AP 1 | Symphysis widening < 2.5 cm | Non-operative. Protected weight bearing |
| AP 2 | Symphysis widening > 2.5 cm. Anterior SI joint diastasis . Posterior SI ligaments intact. Disruption of sacrospinous and sacrotuberous ligaments. | Anterior symphyseal plate or external fixator +/- posterior fixation |
| AP 3 | Disruption of anterior and posterior SI ligaments (SI dislocation). Disruption of sacrospinous and sacrotuberous ligaments. Associated with vascular injury | Anterior symphyseal multi-hole plate or external fixator and posterior stabilization with SI screws or plate/screws |
| LC 1 | Oblique or transverse ramus fracture and ipsilateral anterior sacral ala compression fracture. | Non-operative. Protected weight bearing (complete, comminuted sacral component. Weight bearing as tolerated (simple, incomplete sacral fracture). |
| LC 2 | Rami fracture and ipsilateral posterior ilium fracture dislocation (crescent fracture). | Open reduction and internal fixation of ilium |
| LC 3 | Ipsilateral lateral compression and contralateral APC (windswept pelvis). Common mechanism is rollover vehicle accident or pedestrian vs auto. | Posterior stabilization with plate or SI screws as needed. Percutaneous or open based on injury pattern and surgeon preference. |
| VS | Posterior and superior directed force. Associated with the highest risk of hypovolemic shock (63%); mortality rate up to 25% | Posterior stabilization with plate or SI screws as needed. Percutaneous or open based on injury pattern and surgeon preference. |
References:
Khurana, B., et al. (2014). “Pelvic ring fractures: what the orthopedic surgeon wants to know.” Radiographics 34(5): 1317-1333.
Young JW, Burgess AR, Brumback RJ, Poka A. (1986). “Pelvic fractures: value of plain radiography in early assessment and management.” Radiology 160(2): 445–451.