Executive Editor: Peter Trafton

Authors: Rahul Banerjee, Peter Brink, Matej Cimerman, Tim Pohlemann, Matevz Tomazevic

Pelvic ring - A2.2/3

back to skeleton

Glossary

General considerations

Unless there is significant displacement and/or perineal bony prominence, these purely anterior pelvic arch fractures are usually treated nonoperatively. With significant displacement, painful nonunion may occur as a delayed indication for surgery.

It is essential to confirm that the posterior arch is stable, and that the anterior arch injuries are not a sign of occult pelvic ring instability (e.g. posterior tenderness, instability, or CT evidence of unstable injury).

Nonoperative
Main indication Skill Equipment
Acceptable fracture deformity Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Closed A2.2 and A2.3 fractures (purely anterior arch injuries from direct blow) with acceptable deformity and displacement
Pubic symphysis plate
Main indication Skill Equipment
Significant symphyseal displacement Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Symphyseal disruption with significant displacement and/or persistent pain
  • Need for repair of combined symphysis and ramus injury
  • Open injury
Pubic ramus plate
Main indication Skill Equipment
Significant displacement Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Significant displacement of ramus fracture(s)
  • Displaced fracture producing perineal deformity
  • Symptomatic nonunion

Contraindications

  • Poor soft tissue condition in the surgical area
Pubic ramus screw
Main indication Skill Equipment
Significant displacement Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Significant displacement and/or failure to heal
  • Displaced fracture, including perineal deformity

Advantage

  • Minimally invasive alternative to plate fixation, if reducible and technically feasible
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

2016-10-20