Rethinking LC-type in Young-Burgess classification of pelvic fracture: A retrospective study

Lateral injuries are the most common type of pelvic fracture, and the Young-Burgess classification system is the most widely used system for classifying pelvic fractures. However, as the complexity of clinical cases increases, the Lateral Compression (LC) subtypes in the Young-Burgess classification system can no longer meet the practical needs. This study aimed to reassess the validity of the LC types by exploring clinical cases that the LC subtypes could not categorize. This study was a retrospective analysis of patients with pelvic fractures admitted to our trauma center between January 2019 and December 2024. Inclusion criteria included age between 18 and 80 years, high-energy injury, closed pelvic fracture, and complete preoperative X-ray and computed tomography images. Preoperative X-ray and computed tomography imaging were used to assess fracture displacement and sacroiliac joint injury. Two senior orthopedic surgeons performed the Young-Burgess classification of all patients, and 3 new LC subtypes were proposed after an in-depth discussion of those cases in which the Young-Burgess system could not be applied for classification. A total of 148 patients were included in the study: 96 (64.9%) males and 52 (35.1%) females, with an average age of 48 years (range 18-78 years). The most common trauma mechanism was a traffic accident. 58.8% of the patients showed LC-type injuries, of which 39.2% were LC1, 18.2% LC2, and 1.4% LC3. Additionally, 6.7% of patients had anterior posterior compression-type injuries, 7.5% vertical shear-type injuries, and 6.7% combined mechanism-type injuries. Thirty patients (20.3%) could not be classified according to the current Young-Burgess classification. All unclassifiable fracture types could be attributed to LC injuries, but no corresponding subtype could be found in the existing classification. Specifically, there were 3 main types: comminuted iliac wing fractures in 12 cases, unilateral LC1 combined with LC2 fractures in 10 cases, and bilateral LC1-type fractures in 8 cases. This study provides increasing evidence that the types of fractures exhibit diversity in the context of pelvic lateral injuries. It is necessary to appropriately increase the subtypes of the LC classification to enrich the Young-Burgess classification system, thus more effectively guiding clinical practice.