Classification of Tile from 1984 for Pelvic Fractures

 

Directions of injurious force:

(1) anteroposterior compression

(2) lateral compression

(3) vertical shear

(4) miscellaneous (complex)

Direction of Force	Stability	State of Posterior Sacroiliac Complex
anteroposterior compression	stable	intact
lateral compression	stable	impacted
vertical shear	unstable	disrupted
miscellaneous	unstable	disrupted

 

Types of anteroposterior fractures:

(1) Type I: open book fracture, which has 3 Stages

(1a) Stage I: interruption of the pubic symphysis with gap < 2.5 cm

(1b) Stage II: interruption of the pubic symphysis with gap >= 2.5 cm and disruption of the sacrospinous ligaments

(1c) Stage III: complete disruption of the anterior sacroiliac ligaments

(2) Type II: four rami fracture

 

Types of lateral compression fractures

(1) Type I: ipsilateral anterior (includes interruption of the pubic symphysis) and posterior injury

(2) Type II: contralateral anterior and posterior injury ("bucket handle")

(3) Type III: four rami fracture ("straddle" or "butterfly") with posterior injury

(3a) a variation includes interruption of the pubis symphysis and fractures of both rami on one side, with involvement of the anterior column of the acetabulum

 

Vertical shear (also known as Malgaigne fractures) - consist of combinations of:

(1) unilateral and bilateral disruption of the posterior sacroiliac joint

(2) anterior disruption of the pubic symphysis, or 1 or more pubic rami fractures

 

Types of miscellaneous complex fractures:

(1) bilateral disruption of posterior sacroiliac joints with intact anterior arch

(2) pelvic ring fracture with associated acetabular fracture

 

Fractures associated with a high incidence of pelvic visceral injuries (genitourinary, gastrointestinal, neurological and/or vascular):

(1) anteroposterior compression Type I Stage III

(2) lateral compression Type III

(3) vertical shear

 

Limitations - Some patterns that I do not see a classification for include:

(1) anteroposterior compression with 1-3 pubic rami fractured

(2) lateral compression with both posterior sacroiliac joints impacted