Executive Editor: Peter Trafton

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

Pelvic ring - C1.3

back to skeleton

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.

C1.3 pelvic ring injuries are unilateral totally unstable sacral fractures. They are at risk of persistent pain, deformity, and possible nonunion.

Particularly if transforaminal or central in location, sacral fractures may be associated with nerve root injuries. Careful examination is required to identify these patients, who should be considered for decompressive laminectomy as well as reduction and fixation.

Anatomic reduction and stable fixation of both posterior and anterior injuries is necessary. Various anterior pelvic arch injuries are possible. Their reduction and fixation helps restore pelvic alignment, and adds to the stability of the essential posterior repair.

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 possibility of posterior ring fixation
  • Proximal displacement of the involved hemipelvis or risk thereof
  • Need to delay definitive surgery because of patient's condition

Contraindications

  • Skeletal traction should not be applied if the involved hemipelvis is distally &/or anteriorly displaced. A circumferential wrap should be applied.
  • Ability to provide comprehensive pelvic ring fixation without excessive delay
Operative treatment
Main indication Skill Equipment
C1.3 injury; nerve root involvement Some specialized surgical experience 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

  • C1.3 pelvic ring injury (Completely unstable sacral fracture)
  • Lumbo-sacral nerve root injury
*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