# Pelvic Fracture > Pelvic fracture for FMGE Surgery: Tile and Young-Burgess patterns, pelvic binder, haemorrhage control, retrograde urethrogram before catheterisation. - Canonical URL: https://prepelephant.com/topics/fmge/surgery/pelvic-fracture-fmge - Exam / course: FMGE · Subject: Surgery - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Pelvic Fracture", PrepElephant, https://prepelephant.com/topics/fmge/surgery/pelvic-fracture-fmge ## Direct answer A fractured pelvis is a haemorrhage problem wearing an orthopaedic costume: the ring's cancellous bone and rich venous plexus bleed hundreds of millilitres after high-energy disruption, so the unstable patient with a pelvic fracture is resuscitated with a pelvic binder centred on the greater trochanters closing the open book, blood products, and rapid decisions — external fixation or C-clamp, preperitoneal packing, and angioembolisation for arterial bleeding. Mechanism sorts the patterns: lateral compression (the commonest, from side impacts), anteroposterior compression opening the symphysis like a book, and vertical shear (Malgaigne) unstable in all planes — the Young-Burgess system — while Tile grades stability as A (stable), B (rotationally unstable, vertically stable) and C (unstable in both). Blood at the meatus, a high-riding prostate or perineal bruising in a male mandates a retrograde urethrogram before any catheter attempt. ## What you must remember - **Classification pairs:** Young-Burgess types by mechanism — lateral compression, anteropostercer compression (open book), vertical shear, combined — and Tile by stability: A stable, B rotationally unstable (open-book or lateral compression injury of the ring), C vertically and rotationally unstable. - **Haemorrhage source order:** venous plexus and cancellous bone bleeding account for most blood loss (which is why mechanical closure works), with arterial bleeding (superior gluteal, internal iliac branches) in a minority that needs angioembolisation; the retroperitoneum can conceal litres. - **Resuscitation sequence for the unstable pelvis:** pelvic binder at the level of the trochanters, permissive hypotension until control, balanced transfusion, then external fixation or anterior C-clamp, preperitoneal pelvic packing, and angiography when bleeding continues or a blush is seen on CT. - **Urological red flags:** blood at the external meatus, perineal or scrotal haematoma, high-riding or impalpable prostate, inability to void — posterior urethral injury until a retrograde urethrogram says otherwise; a bladder rupture accompanies both blunt ring disruption and straddle injuries; do not pass a catheter blindly when these signs exist. - **Associated injuries to hunt:** head injury, intra-abdominal solid organ injury (FAST then CT), vaginal laceration making it an open fracture, sciatic and lumbosacral plexus injury, and death from haemorrhage in the vertically unstable elderly. - **Special patterns:** straddle fracture (all four pubic rami) with urethral and bladder injury; Malgaigne fracture — vertical shear through the ring (historically through rami plus sacroiliac joint) with limb shortening; open-book with symphyseal diastasis over about 2.5 cm meaning torn sacrotuberous and sacrospinous ligaments. - **Stable injuries:** isolated pubic ramus fractures in the elderly after a fall and avulsion injuries are treated conservatively with analgesia and early mobilisation; the exam contrast is always conservative ramus versus operated open-book or vertical shear. - **Fixation hardware:** symphyseal plating and sacroiliac screws for definitive stabilization; the binder must be removed within about 24 hours to avoid pressure necrosis once stability is achieved. ## A worked trauma pathway A 30-year-old falls from a height of six metres onto his left side, arriving with a blood pressure of 90/60, a pulse of 120, and pain over the pelvis; compression of the iliac wings reproduces pain and the left leg appears shortened and externally rotated. Reasoning in order: trauma team activation, pelvic binder applied at the trochanters before any log-roll manipulation, two units of blood ordered early under a massive transfusion protocol, FAST negative for intraperitoneal fluid. Because the mechanism is vertical shear and he remains unstable after binder and products, the pathway runs to CT if he stabilises — showing sacroiliac disruption with a contrast blush — followed by angioembolisation of the bleeding internal iliac branch and definitive sacroiliac screw fixation. Blood is noticed at his meatus during catheter preparation, so the retrograde urethrogram precedes catheterisation: a partial posterior urethral injury allows a gentle single attempt, otherwise a suprapubic catheter is placed. Had the same mechanism produced a stable lateral compression injury with normal vitals, the treatment would have been analgesia and mobilisation — the exam's favourite stability-based fork. ## How the exam frames it Three question shapes repeat. First, classification: match the mechanism to the pattern (side impact to lateral compression, head-on to open book, fall from height to vertical shear) and the pattern to stability. Second, the urology trap: catheter first versus retrograde urethrogram first — meatal blood, perineal haematoma or high-riding prostate always earns the urethrogram; passing a catheter through a torn urethra converts partial injury to complete. Third, the resuscitation order: binder, then products, then fixation or packing or embolisation — with the tested fact that most pelvic bleeding is venous, which is why closing the ring, not opening the abdomen, stops it. ## Frequently asked questions ### How are pelvic fractures classified by stability? Tile type A are stable, type B rotationally unstable but vertically stable (open-book and lateral compression patterns), and type C unstable in rotation and vertical planes; Young-Burgess classifies by mechanism into lateral compression, anteropostercer compression and vertical shear. ### Why is a pelvic binder applied in the unstable patient? Because most pelvic haemorrhage is venous and from cancellous bone, mechanically closing the open-book deformity reduces pelvic volume and tamponades the bleeding alongside resuscitation. ### What is the role of angioembolisation in pelvic fracture? It treats persistent arterial bleeding — typically from internal iliac branches such as the superior gluteal artery — suspected by continued instability despite binder and fixation or a contrast blush on CT. ### What signs suggest urethral injury before catheterisation? Blood at the external meatus, perineal or scrotal haematoma, a high-riding or impalpable prostate, and inability to void; a retrograde urethrogram is performed before any catheter attempt. ### What is a straddle fracture and what does it injure? Fractures of all four pubic rami from a direct fall onto the perineum, carrying a high association with bladder and urethral injury.