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.
These patients are at risk of persistent pain, deformity, and possible nonunion. 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 | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Unstable pelvic injury without availability of posterior ring fixation |  |
 |
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
- Skeletal traction should not be applied if the involved hemipelvis is distally and/or anteriorly displaced. A circumferential wrap should be applied.
- Availability of comprehensive pelvic ring fixation without excessive delay
| Operative treatment | ||
| Main indication | Skill | Equipment |
|---|---|---|
| All unilateral complete distruption injuries of the posterior arch through the SI joint |  |
 |
Before proceeding with definitive repairs, the patient must be fully resuscitated, fully evaluated, and fit for anesthesia and surgery by a prepared team.
Indications
- Unilateral unstable complete injury through the SI joint
| *Skill | |
|---|---|
 |
Basic surgical experience, no specialized skills |
|
Some specialized surgical experience |
|
Highly experienced and skilled surgeon |
| *Equipment | |
|---|---|
|
Basic equipment only |
 |
Simple surgical and imaging resources |
|
Full specialized surgical and imaging resources |