Executive Editor: Peter Trafton

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

Pelvic ring - B3

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Glossary

General considerations

Before proceeding with definitive repairs, the patient must be fully resuscitated, fully evaluated, and fit for anesthesia and surgery by a prepared team.

B3 pelvic ring injuries are bilateral, posteriorly. They include features either or both B1 and B2 unilateral ring disruptions, but with greater instability. Internal fixation is recommended at least anteriorly. However posterior fixation on one or both sides may also be necessary to restore pelvic alignment and stability.

Because of the bilateral posterior fractures, pelvic asymmetry is frequently present and requires attention during surgical repair. Symmetry should be restored, so that the pubic symphysis is returned to the midline, that acetabular alignment is symmetric.

Nonoperative
Main indication Skill Equipment
Minimally displaced, stable injuries Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Minimally displaced injuries without evidence of instability

Contraindications

  • Unstable B3 injuries and/or unacceptable deformity
External fixation and traction (resource-limited)
Main indication Skill Equipment
Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only

Indications

  • Unstable pelvic injury without availability of posterior ring fixation
  • Proximal displacement of the involved hemipelvis or risk thereof
  • Need to delay definitive surgery because of patient's condition

Contraindications

  • Availability of comprehensive pelvic ring fixation without excessive delay
Operative treatment
Main indication Skill Equipment
Pelvic deformity; symphyseal disruption Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Before proceeding with definitive repairs, the patient must be fully resuscitated, fully evaluated, and fit for anesthesia and surgery by a prepared team.

Indications

  • Significant rotational deformity, especially with pubic symphysis involvement
  • Locked pubic symphysis
  • Tilt fracture
  • Insufficient lower extremity external rotation
  • Progressive deformity or risk thereof
*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

v1.0 2015-12-10