Tile's 1988 landmark review asks which pelvic ring fractures actually need fixation. Drawing on 494 fractures and a 218-patient natural history study with mean 5.6-year follow-up, it presents a stability-based three-type classification linking fracture pattern to operative indications. This paper established the framework that all subsequent pelvic trauma literature is built on.
When a trauma patient rolls in with a pelvic fracture, the first question is vertical stability — and Tile's classification gives you the answer in three types.
If the posterior sacroiliac complex is intact, the pelvis is rotationally unstable at worst (Type B). Anterior stabilization. External fixation or symphysis plating. Is sufficient. If the posterior complex is disrupted, you have a Type C injury, and no amount of anterior fixation will hold it: biomechanical data shows anterior frames fail under 20 kg load.
For Type C injuries, apply an anterior external frame acutely to restore pelvic volume, reduce hemorrhage, and buy time. Then plan posterior internal fixation definitively, ideally 5-7 days post-injury when the patient has stabilized.
The 2.5 cm symphysis gap threshold in open-book injuries is board-testable and clinically actionable: under 2.5 cm means no posterior lesion and no stabilization needed. Over 2.5 cm means the sacrospinous and anterior sacroiliac ligaments are torn. Stabilize it.
This classification became the direct precursor to the AO/OTA pelvic fracture system and remains the conceptual foundation for percutaneous iliosacral screw fixation used today.
Tile's 1988 landmark review asks which pelvic ring fractures actually need fixation. Drawing on 494 fractures and a 218-patient natural history study with mean 5.6-year follow-up, it presents a stability-based three-type classification linking fracture pattern to operative indications. This paper established the framework that all subsequent pelvic trauma literature is built on.
When a trauma patient rolls in with a pelvic fracture, the first question is vertical stability — and Tile's classification gives you the answer in three types.
If the posterior sacroiliac complex is intact, the pelvis is rotationally unstable at worst (Type B). Anterior stabilization. External fixation or symphysis plating. Is sufficient. If the posterior complex is disrupted, you have a Type C injury, and no amount of anterior fixation will hold it: biomechanical data shows anterior frames fail under 20 kg load.
For Type C injuries, apply an anterior external frame acutely to restore pelvic volume, reduce hemorrhage, and buy time. Then plan posterior internal fixation definitively, ideally 5-7 days post-injury when the patient has stabilized.
The 2.5 cm symphysis gap threshold in open-book injuries is board-testable and clinically actionable: under 2.5 cm means no posterior lesion and no stabilization needed. Over 2.5 cm means the sacrospinous and anterior sacroiliac ligaments are torn. Stabilize it.
This classification became the direct precursor to the AO/OTA pelvic fracture system and remains the conceptual foundation for percutaneous iliosacral screw fixation used today.