Two systems are worldwide accepted for the classification of pelvic ring lesions – the classification of Marvin Tile, adopted by ASIF/OTA, and of J. W. Young and A. Burgess. Both classification systems do not describe bony lesions only, but also take injuries to soft-tissue structures such as dislocations of the symphysis pubis, of the sacroiliac joint as well as disruptions of the ligamentous structures of the pelvic bottom and the iliolumbar ligament into account.
Fragility fractures of the pelvic ring represent a spectrum of pathologies. But there is an important difference with the pelvic ring lesions of the younger adults. In elderly patients with fragile bone, the strength of the bony structures of the pelvis is lower than this of the surrounding ligaments. Fragility fractures of the pelvis are mainly characterized by a disruption of bony structures only. As a consequence, the amount of instability in fragility fractures of the pelvis is not comparable with that of an open book or vertical shear lesion on younger adults. Some fragility fracture patterns of the pelvis therefore do not fit into the classification systems of Tile or Young-Burgess.
How do you classify fragility fractures of the pelvis? Do you think we need a new classification taking into account some specific features of these entities?
Hi Alexander
Why do we need to classify everything? As a reconstructive surgeon I have had to deal with many emergency and non-emergency ligament and bony fractures . Classifications are totally useless in these situations. What one needs is a good knowledge of normal pelvic floor anatomy (which is quite different from cadaveric anatomy, as all the structures are tensioned). Beyond a minimal useful point, classifications only burden and confuse a clinician. Karl Popper described such inventions as "artificial model languages."
Popper stated: “thus the method of constructing artificial model languages is incapable of tackling the problems of the growth of our knowledge”; and “It is a result of their poverty that they yield only the most crude and the most misleading model of the growth of knowledge - the model of an accumulating heap of observation statements”.
Popper KR. A survey of some fundamental problems. 0n the problem of a theory of scientific method. Theories. Falsifiability. The problem of the empirical basis. Degrees oftestibility. Simplicity. The Logic of Scientific Discovery. 1980; Unwin, Hyman, London, 27-146.
So stick with the anatomy. Just describe what you find and what you do
I hope this is helpful.
Peter Petros
Professor PEP Petros DSc DS (UWA) PhD (Uppsala) MB BS MD (Syd) FRCOG (Lond) FRANZCOG
Reconstructive Pelvic Floor Surgeon and Certified Urogynaecologist
Hon. Professor, University of NSW Professorial Dept of Surgery, St Vincent’s Hospital Sydney
Adjunct Professor, University of Western Australia School of Mechanical and Chemical Engineering, Perth WA
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