Reviewed and revised 6 June 2016
There are various systems for classification, these are the 2 most often used:
- Tile classification
- based on pelvic stability and useful for guiding pelvic reconstruction
- Young-Burgess classification
- more useful in the ED as it is based on mechanism and also indicates stability (I to III subclassification)
- Tile A
— Rotationally and vertically stable
— pubic ramus fracture, iliac wing fracture, pubic stasis diastasis <2.5 cm
- Tile B
— Rotationally unstable, vertically stable
B1: pubic symphysis diastasis >2.5 cm and widening of the sacroiliac joints (open book fracture due to external rotation forces on the hemipelvises)
B2: pubic symphysis overriding (internal rotation force on hemipelvises)
- Tile C
— Rotationally and vertically unstable
— disruption of SI joints due to vertical shear forces
C3: involves acetabulum
- Anteroposterior compression (APC)
— common feature is diastasis of the pubic symphysis or vertical fracture of the pubic rami
APC I: Pubic symphyseal diastasis, <2.5 cm, no significant posterior ring injury (stable)
APC II: Pubic symphyseal diastasis >2.5 cm, tearing of anterior sacral ligaments (rotationally unstable, vertically stable)
APC III: Hemipelvis separation with complete disruption of pubic symphysis and posterior ligament complexes (completely unstable)
- Lateral compression (LC)
— common feature is a transverse fracture of the pubic rami
LC I: Posterior compression of sacroiliac (SI) joint without ligament disruption (stable)
LC II: Posterior SI ligament rupture, sacral crush injury or iliac wing fracture (rotationally unstable, vertically stable)
LC III: LC II, with open book (APC) injury to contralateral pelvis (completely unstable)
- Vertical shear injuries (VS)
— common feature is a vertical fracture of the pubic rami
— displaced fractures of the anterior rami and posterior columns, including SI dislocation (completely unstable)
- Combined mechanism (CM) fractures
— massive pelvic injuries that don’t fit the other categories (completely unstable)
Additional comments on the Young-Burgess classification:
- APC fractures typically result from ‘head on’ collisions, LS fractures from ‘side on’ impacts and VS fractures from falls from height or ‘head on’ motor vehicle crashes.
- The Young-Burgess classification was originally thought to predict extent of haemorrhage but this has not been supported by subsequent research. The ‘lesser’ fractures can still result in arterial haemorrhage in some cases.
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.