Vertical Shear

Vertical shear




Unstable injuries

Complete disruption of both the anterior and posterior ring


5 - 20% of pelvic fractures




Axial load

Motor vehicle accident

Fall from height




Anterior ring

- pubic symphysis disruption

- fracture of the superior and inferior pubic ramus

- fracture acetabulum


Posterior ring

- fracture sacrum / SI joint / ilium


Initial Management


Femoral steinman pin + 20lb weight to reduce vertical displacement

Anterior external fixation to pelvis


Vert shear inital management



Definitive Management


Verticla shearLumbosacral fixation

Lumbosacral fixation with SI screw - triangular osteosynthesis


Vert shear CTVertical shear fixation


Posterior stabilisation critical



- closed

- open



- sacro-iliac screws

- trans-sacral trans-iliac screws

- trans-iliac posterior tension band plating

- lumbosacral fixation


Anterior stabilisation


Pubic symphysis plates

Percutaneous ramus screws




Griffin et al J Orthop Trauma 2006

- 62 patients with vertical shear fractures treated with SI screws

- increased failure rate in vertical sacral fractures compared sacro-iliac joint dislocation


Tisano et al OTA Int 2020

- 20 vertical shear fractures

- 12 sacro-iliac dislocations and 8 vertical sacral fractures

- no failures in sacro-iliac dislocations

- failure in 4/8 vertical sacral fractures

- 3/4 failures of vertical sacral fracture fixed with single SI screw