{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T12:10:22Z","timestamp":1772021422359,"version":"3.50.1"},"reference-count":22,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background and Objectives: Pelvic ring injuries with symphyseal disruption are classically associated with high-energy mechanisms such as motor vehicle collisions. Recently, waterslides have emerged as an underrecognized but distinct source of severe pelvic trauma. Waterslide-related pelvic trauma represents a distinct biomechanical entity characterized by a supine or semi-supine body position at splashdown, extreme forced hip abduction, asymmetric lower-limb positioning, and abrupt hydrodynamic deceleration. The high descent velocity, abrupt hydrodynamic deceleration, and forced hip abduction at water entry may combine to generate open-book-type pelvic injuries. Evidence guiding diagnosis and surgical management in this setting remains scarce. Materials and Methods: We retrospectively analyzed a consecutive series of adult patients sustaining waterslide-related anterior\u2013posterior compression type II (APC2) pelvic ring injuries. Demographic data and the body mass index (BMI), fracture classification, surgical strategy, complications, and functional outcomes were reviewed. Only patients with complete imaging, operative records, and follow-up were included. Results: Four patients (38\u201372 years) met the inclusion criteria. All sustained rotationally unstable open-book pelvic injuries and were classified as APC2; three were AO\/OTA 61B2.3 and one 61B3.3. All patients were overweight or obese (BMI 27.2\u201331.2). Pelvic binders provided an effective acute reduction in symphyseal diastasis; however, in one bilateral injury, CT imaging obtained with the binder in situ masked posterior ligamentous instability. Definitive surgical fixation was performed in all cases. Early mechanical failure occurred in two patients treated with short anterior symphyseal plate constructs. In the bilateral injury, isolated anterior fixation failed repeatedly until posterior sacroiliac stabilization was added. No deep infections or thromboembolic events occurred. Although two patients required short observational ICU stays, none were admitted for hemodynamic instability or pelvic bleeding. Conclusions: At 12-month follow-up, three patients achieved pain-free ambulation without assistive devices, while one patient required intermittent use of a single crutch; all patients regained independence in daily activities. Waterslide accidents represent a high-energy injury mechanism capable of producing severe APC2 pelvic disruptions, particularly in patients with an elevated BMI. Awareness of this mechanism and meticulous assessment of posterior stability are essential to avoid under-treatment and mechanical failure.<\/jats:p>","DOI":"10.3390\/jcm15051729","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T10:59:16Z","timestamp":1772017156000},"page":"1729","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Open Book on the Water Slide: A Case Series of APC2 Pelvic Ring Injuries from High-Energy Aquatic Accidents"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5059-7099","authenticated-orcid":false,"given":"Adeeb","family":"Algaith","sequence":"first","affiliation":[{"name":"Department of Traumatology and Orthopaedics, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kapil","family":"Soni","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Orthopaedics, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Attila","family":"M\u00e1csai","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Orthopaedics, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0530-763X","authenticated-orcid":false,"given":"Lilla","family":"S\u00e1ndor","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Orthopaedics, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1kos","family":"Csonka","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Orthopaedics, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Endre","family":"Varga","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Orthopaedics, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4746-9792","authenticated-orcid":false,"given":"Petra","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Orthopaedics, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"ref_1","unstructured":"Perry, K., Mabrouk, A., and Chauvin, B.J. (2025). Pelvic Ring Injuries. StatPearls, StatPearls Publishing."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"97","DOI":"10.7600\/jpfsm.13.97","article-title":"Anatomy of pelvic trauma: Structure and function of ligaments around sacroiliac and pubic symphysis, and bone mineral density of pelvic bones","volume":"13","author":"Inagaki","year":"2024","journal-title":"J. Phys. Fit. Sports Med."},{"key":"ref_3","unstructured":"World Health Organization (2025, December 19). Road Traffic Injuries. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/road-traffic-injuries."},{"key":"ref_4","unstructured":"(2025, December 19). Pelvic Trauma: Initial Evaluation and Management. Available online: https:\/\/www.uptodate.com."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s00198-022-06636-z","article-title":"Epidemiology of pelvic and acetabular fractures in the USA from 2007 to 2014","volume":"34","author":"Weaver","year":"2023","journal-title":"Osteoporos. Int."},{"key":"ref_6","unstructured":"(2025, December 19). Fractures and Dislocations of the Pelvic Ring n.d. Available online: https:\/\/teachmeorthopedics.info\/fractures-and-dislocations-of-the-pelvic-ring."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.injury.2022.12.007","article-title":"Epidemiology and burden of pelvic fractures: Results from the Global Burden of Disease Study 2019","volume":"54","author":"Hu","year":"2023","journal-title":"Injury"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1097\/00005373-199007000-00015","article-title":"Pelvic ring disruptions: Effective classification system and treatment protocols","volume":"30","author":"Burgess","year":"1990","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"143","DOI":"10.5435\/00124635-199605000-00004","article-title":"Acute Pelvic Fractures: I. Causation and Classification","volume":"4","author":"Tile","year":"1996","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and Dislocation Classification Compendium\u20142018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J. Orthop. Trauma"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.injury.2004.05.029","article-title":"Open pelvic fractures: Epidemiology, current concepts of management and outcome","volume":"36","author":"Grotz","year":"2005","journal-title":"Injury"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2338","DOI":"10.1007\/s11999-014-3693-8","article-title":"Classifications in Brief: Young and Burgess Classification of Pelvic Ring Injuries","volume":"472","author":"Alton","year":"2014","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_13","unstructured":"(2025, December 19). Pelvic Ring Fractures. n.d. Available online: https:\/\/www.orthobullets.com\/trauma\/1030\/pelvic-ring-fractures."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e000008","DOI":"10.1136\/tsaco-2016-000008","article-title":"Water slide injuries in Jamaica","volume":"1","author":"Fletcher","year":"2016","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1016\/j.jcot.2018.01.002","article-title":"Pubic symphysis diastasis sustained from a waterslide injury","volume":"9","author":"Williamson","year":"2018","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1159\/000509259","article-title":"A Water Slide Accident Resulting in an Open Book Pelvic Injury and Subsequent Pulmonary Embolus: A Case Report","volume":"3","author":"Fletcher","year":"2020","journal-title":"Case Rep. Orthop. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.2106\/JBJS.CC.21.00055","article-title":"Theme Park Water Slides: A New Mechanism of Causing 61B2.3 Pelvic Ring Injuries","volume":"11","author":"Shaath","year":"2021","journal-title":"JBJS Case Connect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"232","DOI":"10.25259\/JMSR_32_2022","article-title":"Complex pelvic injury in a morbidly obese patient\u2014A case report","volume":"6","year":"2022","journal-title":"J. Musculoskelet. Surg. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e225","DOI":"10.3346\/jkms.2024.39.e225","article-title":"CAse-BAsed REview sTandards (CABARET): Considerations for Authors, Reviewers, and Editors","volume":"30","author":"Benlidayi","year":"2024","journal-title":"J. Korean Med. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/s10140-016-1430-1","article-title":"CT incidence of Morel-Lavallee lesions in patients with pelvic fractures: A 4-year experience at a level 1 trauma center","volume":"6","author":"Beckmann","year":"2016","journal-title":"Emerg. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1111\/ans.12700","article-title":"Functional and return to work outcomes following major trauma involving severe pelvic ring fracture","volume":"85","author":"Gabbe","year":"2015","journal-title":"ANZ J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.jcot.2020.08.009","article-title":"Association between Young-Burgess pelvic ring injury classification and concomitant injuries requiring urgent intervention","volume":"11","author":"Coleman","year":"2020","journal-title":"J. Clin. Orthop. Trauma"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1729\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T11:25:36Z","timestamp":1772018736000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1729"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,25]]},"references-count":22,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051729"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051729","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,25]]}}}