Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries?
OBJECTIVE
The objectives of this study were to evaluate the ability of the Young-Burgess classification system to predict mortality, transfusion requirements, and nonorthopaedic injuries in patients with pelvic ring fractures and to determine whether mortality rates after pelvic fractures have changed over time.


METHODS
Retrospective review.


METHODS
Level I trauma center.


METHODS
One thousand two hundred forty-eight patients with pelvic fractures during a 7-year period.


METHODS
None.


METHODS
Mortality at index admission, transfusion requirement during first 24 hours, and presence of nonorthopaedic injuries as a function of Young-Burgess pelvic classification type. Mortality compared with historic controls.


RESULTS
Despite a relatively large sample size, the ability of the Young-Burgess system to predict mortality only approached statistical significance (P = 0.07, Kruskal-Wallis). The Young-Burgess system differentiated transfusion requirements--lateral compression Type 3 (LC3) and anteroposterior compression Types 2 (APC2) and 3 (APC3) fractures had higher transfusion requirements than did lateral compression Type 1 (LC1), anteroposterior compression Type 1 (APC1), and vertical shear (VS) (P < 0.05)--but was not as useful at predicting head, chest, or abdomen injuries. Dividing fractures into stable and unstable types allowed the system to predict mortality rates, abdomen injury rates, and transfusion requirements. Overall mortality in the study group was 9.1%, unchanged from original Young-Burgess studies 15 years previously (P = 0.3).


CONCLUSIONS
The Young-Burgess system is useful for predicting transfusion requirements. For the system to predict mortality or nonorthopaedic injuries, fractures must be divided into stable (APC1, LC1) and unstable (APC2, APC3, LC2, LC3, VS, combined mechanism of injury) types. LC1 injuries are very common and not always benign (overall mortality rate, 8.2%).
Manson
Theodore
T
R Adams Cowley Shock Trauma Center, Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
O'Toole
Robert V
RV
Whitney
Augusta
A
Duggan
Brian
B
Sciadini
Marcus
M
Nascone
Jason
J
D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015897:Comorbidity; D050815:Fractures, Compression / Q000145:classification* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008396:Maryland / Q000453:epidemiology; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D015599:Trauma Severity Indices