This page is educational and is not a substitute for professional medical advice, diagnosis, or treatment.
Please ask a qualified health professional about symptoms, treatment decisions, or concerns about your own condition.
Emergency? If symptoms are severe, rapidly worsening, or you think it may be an emergency, call your local emergency number or go to the nearest emergency department.
Bones & Joints
Anteroposterior compression (APC) pelvic injuries, commonly called 'open book' fractures, occur when a front-to-back crushing force causes the pelvis to spring open like a book—most often from high-energy trauma such as car accidents (side-impact or head-on collisions) or pedestrian strikes, with injury severity ranging from mild pubic symphysis widening (APC I) to complete disruption of the pelvic ring with life-threatening bleeding from torn pelvic veins and arteries (APC III requiring emergency stabilization). In Australia, major trauma centres manage these injuries with immediate resuscitation, temporary external fixation or pelvic binders to control hemorrhage, followed by definitive surgical fixation once the patient is stable—recovery typically takes 3-6 months for walking and 6-12 months for return to normal activities, with outcomes depending on associated injuries to bladder, urethra, nerves, and blood vessels that occur in up to 40-60% of severe cases.
What it is and why it happens
Anteroposterior compression (APC) pelvic injuries, commonly called 'open book' fractures, occur when a front-to-back crushing force causes the pelvis to spring open like a book—most often from high-energy trauma such as car accidents (side-impact or head-on collisions) or pedestrian strikes, with injury severity ranging from mild pubic symphysis widening (APC I) to complete disruption of the pelvic ring with life-threatening bleeding from torn pelvic veins and arteries (APC III requiring emergency stabilization). In Australia, major trauma centres manage these injuries with immediate resuscitation, temporary external fixation or pelvic binders to control hemorrhage, followed by definitive surgical fixation once the patient is stable—recovery typically takes 3-6 months for walking and 6-12 months for return to normal activities, with outcomes depending on associated injuries to bladder, urethra, nerves, and blood vessels that occur in up to 40-60% of severe cases.