Classification of Pelvic Fractures

Reviewed and revised 6 June 2016

OVERVIEW

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 CLASSIFICATION

• 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
  C1: unilateral
  C2: bilateral
  C3: involves acetabulum

YOUNG-BURGESS CLASSIFICATION

• 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.

References

• Tile M. Acute Pelvic Fractures: I. Causation and Classification. J Am Acad Orthop Surg. 1996 May;4(3):143-151
• Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, Bathon GH, Brumback RJ. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990 Jul;30(7):848-56.
• Khurana B, Sheehan SE, Sodickson AD, Weaver MJ. Pelvic ring fractures: what the orthopedic surgeon wants to know. Radiographics. 2014 Sep-Oct;34(5):1317-33.
• Beech G et al. CT Case 053. LITFL