Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

 

 

Pelvic Fracture Classification: Young–Burgess and Tile Systems

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Introduction

Pelvic fracture classification is essential to determine:

• Severity of injury
• Pelvic stability
• Risk of hemorrhage
• Need for surgical intervention

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Clinical Importance

Initial pelvic X-ray and patient condition help classify injuries as:

• Stable (simple)
• Unstable (life-threatening) ? requires urgent resuscitation

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Common Classification Systems

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1. Young–Burgess Classification

• Based on mechanism of injury
• Reflects direction of force

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2. Tile Classification

• Based on pelvic stability

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Young–Burgess Classification

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Types

• Lateral Compression (LC)
• Anteroposterior Compression (APC)
• Vertical Shear (VS)

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Lateral Compression (LC)

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Mechanism

• Internal rotation force on pelvis

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LC Type I

Features

• Sacral compression fracture
• Pubic ramus fracture

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Stability

• Usually stable

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LC Type II

Features

• Crescent fracture of iliac wing
• Posterior sacroiliac ligament injury

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Stability

• Rotationally unstable

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LC Type III (Windswept Pelvis)

Features

• LC injury on one side
• APC injury on opposite side

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Mechanism

• High-energy trauma (e.g., rollover accidents)

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Clinical Significance

• LC I & II – deaths often due to head injury
• LC III – associated with bowel injury

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Anteroposterior Compression (APC)

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Mechanism

• External rotation force
• Direct pelvic impact or forced leg abduction

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Key Feature

Symphysis pubis diastasis (“open-book pelvis”)

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APC Type I

Features

• Symphyseal widening < 2.5 cm
• Ligaments intact

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Stability

• Rotationally & vertically stable

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Treatment

• Conservative

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APC Type II

Features

• Symphyseal widening > 2.5 cm
• Injury to:
  • Sacrospinous ligament
  • Sacrotuberous ligament
  • Anterior SI ligaments

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Stability

• Rotationally unstable
• Vertically stable

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APC Type III

Features

• Complete disruption including posterior SI ligaments

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Stability

• Rotationally + vertically unstable

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Clinical Importance

Highest risk of:

• Severe hemorrhage
• Hemorrhagic shock

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Vertical Shear (VS)

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Mechanism

• Vertical force (e.g., fall from height)

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Features

• Disruption of:
  • Sacroiliac ligaments
  • Pelvic floor

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Stability

• Rotationally unstable
• Vertically unstable

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Clinical Significance

 Associated with:

• Massive bleeding
• High mortality

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Tile Classification

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Concept

Based on pelvic stability

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Types

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Type A – Stable

Examples

• ASIS avulsion (Sartorius)
• AIIS avulsion (Rectus femoris)
• Iliac wing fracture
• Transverse sacral fracture

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Stability

• Pelvic ring intact

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Management

• Conservative

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Type B – Rotationally Unstable, Vertically Stable

Examples

• Open-book injury
• Lateral compression injury
• Bucket-handle injury

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Features

• Rotational instability only

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Type C – Rotationally and Vertically Unstable

Features

• Complete disruption of pelvic ring
• Severe instability

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Clinical Importance

 High risk of:

• Major hemorrhage
• Life-threatening injury

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Bleeding in Pelvic Fractures

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Major Causes of Mortality

• Hemorrhagic shock
• Associated injuries

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Risk Factors

• Age > 60 years
• Open fractures
• High Injury Severity Score (ISS)

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Source of Bleeding

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Venous (90%)

• Cancellous bone
• Pelvic venous plexus

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Arterial (10%)

• Superior gluteal artery
• Obturator artery
• Internal pudendal artery

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Emergency Management

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Pelvic Binder

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Indication

• Open-book (APC) injuries

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Function

• Reduces pelvic volume
• Controls hemorrhage

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Massive Transfusion Protocol

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Ratio

• Packed RBC : Plasma : Platelets = 1 : 1 : 1

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Angiography and Embolization

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Indications

• ~20% of APC and VS injuries
• ~2% of LC injuries

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Surgical Stabilization

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Indications

• Unstable pelvic fractures

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Anterior Fixation

• Multihole plate

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Posterior Fixation

• Percutaneous sacroiliac screws

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Key Exam Points

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Classification Basis

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High-Yield Concepts

• APC III and VS – highest bleeding risk
• LC injuries – often associated with head injury
• 90% bleeding is venous
• Pelvic binder is critical in open-book injuries

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Clinical Insight

Always assess:

• Stability
• Hemodynamic status

These guide:

• Resuscitation
• Definitive management