Fracture of pelvis - Tile classification (original)
The original Tile classification divides pelvic fractures into three basic types according to stability based on the integrity of the posterior sacroiliac complex. It also takes into consideration the force involved. In type A, the fracture does not involve the posterior arch. Type B fracture is a result of rotational forces that cause partial disruption of the posterior sacroiliac complex. Complete disruption of the posterior complex (including the sacrospinous and sacrotuberous ligaments) occurs in type C fractures, that are both rotationally and vertically unstable. The signs of instability include posterior displacement of the hemi-pelvis >1cm, avulsion of the transverse process of L5 and detachment of one insertion of the sacrospinous ligament. Each basic type has subtypes.
| Type | Description |
|---|---|
| Type A: stable, minimally displaced | A1: fracture does not involve the pelvic ring (avulsion fracture or fracture of the iliac wing) |
| A2: stable or minimally displaced fracture of the pelvic ring | |
| Type B: rotationally unstable, vertically stable | B1: anteroposterior compression - (open book injury) * |
| B2: lateral compression injury (ipsilateral) | |
| B3: lateral compression injury (contralateral) | |
| Type C: rotationally and vertically unstable | C1: unilateral fracture |
| C2: bilateral fracture | |
| C3: associated with acetabular fracture |
*) Type B1 has three stages:
Stage 1: disruption of the symphysis <2.5cm
Stage 2: separation of the symphysis >2.5cm with disruption of the sacrospinous ligament and the anterior sacroiliac ligament on one side
Stage 3: separation of the symphysis >2.5cm with bilateral disruption of the sacrospinous ligament and the anterior sacroiliac ligament
References:
1. Tile M. Pelvic ring fractures: should they be fixed. J Bone Joint Surg Br, 1988, 70.1: 1-12. .
2. Tile M. Acute pelvic fractures: I. Causation and classification. Journal of the American Academy of Orthopaedic Surgeons, 1996, 4.3: 143-151.