Classification by Tile and Denis | Sacral Fracture

Classification by Tile and Denis

Basically, sacral fractures are classified according to Denis, but because they belong to the category of pelvic injuries, they can also be classified according to the general criteria of a pelvic ring injury. Pelvic ring injuries are classified according to tile and differentiate the severity of the instability of the pelvis. The classification according to Denis provides information about the stability of the sacrum itself and about any accompanying nerve injuries.

These nerve injuries are more probable the more central (medial) the fracture of the coccyx is.

  • Type A fractures include stable fractures in which an intact pelvic ring is still present despite small bony tears.
  • Type B fractures describe partially unstable pelvic fractures because they involve a partial tear of the posterior pelvic ring.
  • Type C fractures describe completely unstable fractures because the posterior pelvic ring is completely broken. 45% of these C fractures are sacral fractures.
  • Type 1 fractures according to Denis are also called transalar sacral fractures and describe lateral fractures of the sacrum, which are located between the sacrum and the iliac vane (ala).
  • Type 2 comprises fractures of the sacrum passing through the small holes (Foramina sacralia ant.

    et post. ).

  • Type 3 according to Denis includes all transverse fractures as well as all central fractures, i.e. those located towards the middle of the body. This type of sacral fracture is associated with a high risk of concomitant nerve damage.

Symptoms

A typical symptom of a sacral fracture is severe pain in the sacrum, which increases especially when sitting. Hematomas are often found around the sacrum, it is sensitive to pressure pain and small blood leaks can occur around the anal region. If nerves are also involved in the sacral fractures, this can lead to sensory disturbances, as well as to motor deficits in the genitals, buttocks and inner thigh area (so-called “breeches anesthesia”). In severe cases this could then be accompanied by faecal and urinary incontinence as well as potency disorders.Since a sacral fracture is often combined with a pelvic ring fracture, loss of gait and soft tissue injuries can also be the consequence and symptom