Tile published a classification of pelvic ring fractures in 1984 that includes the type of force involved and the relative stability of the pelvis afterwards.


Directions of injurious force:

(1) anteroposterior compression

(2) lateral compression

(3) vertical shear

(4) miscellaneous (complex)

Direction of Force


State of Posterior Sacroiliac Complex

anteroposterior compression



lateral compression



vertical shear







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


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