19. Tile Classification
Type A: Stable (Posterior Arch Intact)
A1 Avulsion injury
A2 Iliac wing or anterior arch fracture caused by a direct blow
A3 Transverse sacrococcygeal fracture
Type B: Partially Stable (Incomplete Disruption of Posterior Arch)
B1 Open book injury (external rotation)
B2 Lateral compression injury (internal rotation)
B2-1 Ipsilateral anterior and posterior injuries
B2-2 Contralateral (bucket-handle) injuries
B3 Bilateral
Type C: Unstable (Complete Disruption of Posterior Arch)
C1 Unilateral
C1-1 Iliac fracture
C1-2 Sacroiliac fracture-dislocation
C1-3 Sacral fracture
C2 Bilateral, with one side type B, one side type C
C3 Bilateral
21. Management of Acute
Phase
ATLS
Pelvic binder/ bed sheet hammock/ C
clamp
Traction vs triangular abduction pillow
CMR vs OR vs Referral
Fluid and volume resuscitation
28. Indications for Non-operative
Treatment
Acetabular fracture:
1. Non-displaced & Minimally Displaced Fractures
2. Fractures with Significant Displacement but in
Which the Region of the Joint Involved Is Judged
to Be Unimportant Prognostically
3. Secondary Congruence in Displaced Both-
Column Fractures
4. Medical Contraindications to Surgery
5. Local Soft-Tissue Problems, such as Infection,
Wounds, and Soft-Tissue Lesions from Blunt
Trauma
6. Elderly Patients with Osteoporotic Bone in Whom
Open Reduction May Not Be Feasible
29. Indications for Non-operative
Treatment
Pelvic ring fractures:
1. Widening of the symphysis of <2.5cm
2. Impacted fractures of the anterior
cortex of the sacrum
3. Sacral fracture without a gap
4. Vertical instability usually is defined as
1 cm or more of cephalad migration of
one hemipelvis
30. Nondisplaced and Minimally
Displaced Fractures
traverse the weight bearing dome
displaced <2 mm
depending on the fracture
characteristics
Radiographs
first mobilized
periodically thereafter
non–weight bearing for 6 to 12 weeks
31. Fractures with Significant Displacement
but in which the Region of the Joint
Involved is Judged to be Unimportant
Prognostically
determination is made with the roof
arc measurements
acceptable roof arc measurements
are 25, 45 and 70 degrees for the
anterior, medial, posterior roof arcs
respectively
displaced fractures not exiting the
posterior column above the upper
border of the ischial spine
32. Fractures with Significant Displacement but in
which the Region of the Joint Involved is
Judged to be Unimportant Prognostically
fractures not exiting the anterior
column through the iliac wing
Instability when involving more than
40 - 50% posterior wall fractures
Stability tested with 900 hip flexion
under sedation
33. Roof arc measurements
Consist of anterior, medial and posterior.
Measured on Obturator oblique, AP and
Iliac oblique views respectively.
Formed between lines drawn vertically
through the geometric centre of the
acetabulum and a line from the fracture
line to the geometric centre
Limited use in presence of bicolumnar or
post wall fractures
39. Secondary Congruence in
Displaced Both-Column
Fractures
The concept described by Letournel
comminuted both-column fracture
fragments
fragments free to move independent
of the remaining ilium
reasonable and occasionally
exceptional results
41. Medical Contraindications to
Surgery
Medical contraindications from
multisystem injury
Severe head trauma with a tenuous,
evolving spectrum of injury
Multiple medical co morbidities (CCF,
ESRF, CVA etc.)
Delayed
42. Local Soft-Tissue Problems, such as Infection,
Wounds, and Soft-Tissue Lesions from Blunt
Trauma
Open wound
Morel-Lavallée lesion
Systemic infection
Suprapubic catheter
48. Elderly Patients with Osteoporotic Bone in
Whom Open Reduction May Not Be
Feasible
older than 60 years
osteopenic patients
options
1. mobilization without fixation,
2. percutaneous fixation with mobilization,
3. primary total hip arthroplasty
Avoid prolonged traction and
immobilization
56. Conclusion
The quality of acetabular fracture reduction
is the single most important factor in the
long-term outcome of these patients.
Restoring the Horizontal and vertical
stability is the key in pelvic ring fractures
Surgery should be undertaken only by
surgeons with sufficient experience.
Sound knowledge of common fracture
classification & radiological landmarks
provides crucial tool for decision making.
57. References
Judet R, Judet J, Lanzetta A, Letournel E. Fractures of the acetabulum. Classification and
guiding rules for open reduction. Arch Ortop 1968;81:119–158.
Kang HJ, Ko SH, Kim BS, et al. Principles of fracture management. 1st ed. Seoul: Bummun
education; 2013. pp. 567-579.
Moed BR, Reilly MC. Rockwood and Green's fractures in adult. 7th ed. Robert WB, James DH,
Charles CBPhiladelphia: Lippincott Williams & Wilkins; 2010. pp. 1463-1521.
Müller ME, Allgöwer M. Manual of internal fixation: techniques recommended by the AO-ASIF
goup. 3rd ed. Berlin: Springer-Verlag; 1991.
Tile, 2003. Tile M: Anatomy of the pelvic ring. In: Tile M, Helfet DL, Kellam JF, ed. Fractures
of the pelvis and acetabulum, 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003.
Tile M, Helfet DL, Kellam JF. Fracture of the pelvis and acetabulum. 3rd ed. Phildelphia:
Williams & Wilkins; 2003. pp. 417-833.
Tornetta et al., 1996. Tornetta III P, Dickson K, Matta JM: Outcome of rotationally unstable
pelvic ring injuries treated operatively. Clin Orthop Relat Res 1996; 329:147.
Tornetta and Matta, 1996. Tornetta III P, Matta JM: Outcome of operatively treated unstable
posterior pelvic ring disruptions. Clin Orthop Relat Res 1996; 329:186.
Tornetta and Templeman, 2005. Tornetta III P, Templeman DC: Expected outcomes after pelvic
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