Before proceeding with definitive repairs, the patient must be fully resuscitated, fully evaluated, and fit for anesthesia and surgery by a prepared team.
Successful definitive treatment requires reduction and fixation of both the posterior and anterior injuries, generally completed in a single definitive procedure.
Complete pelvic ring instability may be obvious when displacement is gross, but it may also be occult, when initial displacement has been hidden by elastic recoil, poor imaging studies, or successful reduction by a pelvic binder.
This illustration shows inlet and outlet oblique views, with posterior and proximal translational displacement of a right sacro iliac fracture dislocation, with associated pubic symphysis disruption. Rotational deformity and instability, may also be present.
Emergency care for pelvic ring injuries should be available and preplanned at every trauma hospital. Patients with complex pelvic ring injuries may need to be referred to a specialized center. Definitive care of complex pelvic ring injuries may be centralized so that patient referral may need to be considered.