Pelvic fracture - the disease

Pelvic fracture urethral injury refers to a pathologic condition where a pelvic fractures from high‐energy blunt force trauma can cause injury to the urethra. The incidence of pelvic fracture is approximately 20/100,000 for men and 29/100,000 for women. Nevertheless, male patients are more commonly affected by urethral injury after pelvic fractures due to anatomical predisposition. Not all types of pelvic fractures are commonly associated with urethral injury. The three most commonly used orthopaedic pelvic fracture classifications are: Young-Burgess, Tileand AO/OTA. They all stem from the 1990 Young-Burgess classification system.

Young-Burgess classification

Lateral compression (LC): these are implosion injuries from lateral impact to the innominate bone. The pelvis on the side of the impact rotates toward the midline. The anterior pelvic ligaments are shortened. The anterior pattern of LC fracture may be unilateral, contralateral or bilateral involving one or more sets of pubic rami, one set of which will always have a transverse fracture. It is the extent of the posterior pathology that differentiates the subsets. LC fractures tend to close the pelvic cavity and death, if it occurs, is due to associated non-pelvic injuries.
Anteroposterior compression (APC): all have pubic symphysis diastasis or anterior vertical fracture of the rami. There is no cephalad shift of the hemi-pelvis. Again, it is the extent of the posterior pathology that defines the subsets. APC fractures tend to open up the pelvic cavity and death, if it occurs, is most commonly secondary to bleeding and its complications.
Vertical shear (VS): a symphyseal diastasis or a vertical fracture pattern of the rami occurs anteriorly. VS fractures are distinguished by vertical displacement of the hemi-pelvis and are more likely to be unstable.
Mixed (CM): a combination of fracture patterns and grades.

According with this classification, the lateral compression fractures are more frequently associated with urethral injury. However, data confirming this association are lacking.