Open Book Fractures

Prior to the 1980s and the routine use of CT imaging, most authors used the terms Malgaine, straddle and open book type to describe pelvic fractures. This provided limited detail regarding the type of mechanism of injury and was not particularly useful in planning the management of the patient. 

There maybe fractures of the pubic rami as in Type I. There is further diastasis of the anterior aspect of the sacroiliac joints and these are classically referred to as the open book or spun pelvis type injuries. Sacroiliac diastasis is best assessed by CT. There may be some partial instability on AP compression. In children, there may be fracturing of the adjacent bone rather than ligament rupture. This is a reflection of the relative strength of the ligaments compared with bone in the growing skeleton (Figs. 12.6,12.7). 

This classification system aims to link management and prognostic evaluation with the imaging findings. It is based on the work of Tile and the Association for Osteosynthesis and relates to the site of fractures within the pelvic ring (Fig. 12.15a-c). There are three classifications, A, B and C. In type A fractures, the pelvic ring is stable, type B is partially stable this includes the open-book and bucket-handle fractures which are caused by external- and internal-rotation forces, respectively. In type C injuries, there is complete disruption of the posterior sacroiliac complex. In adults, type A lesions represent 52%, type B 27% and type C 21% (Theumann et al. 2002). The classification is shown in Table 12.1. 

Type B1 fractures are the open book type fracture with external rotation of both iliac wings and Type B2 fractures are lateral compression injuries. TypeB3 is the classical open book type fracture (Fig. 12.17). 

VI.22] AMERICAN SOCIETY FOR TESTING AND MATERIALS, Standard Test Method for Crack Tip Opening Displacement (CTOD) Fracture Toughness Measurement, ASTM E1290-93, Annual Book of ASTM Standards, ASTM, PhUadelphia, PA (1993). 

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