Executive Editor: Peter Trafton

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

Pelvic ring - llium

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.

Vertically oriented fractures of the posterior ilium, are rotationally or totally unstable. Totally unstable fractures require open reduction and fixation of the iliac fracture with anterior arch repair as well. Rotationally unstable fractures are theoretically stable after anterior arch repair, but the actual iliac fracture stability is uncertain so that ORIF of the fracture should be considered. If the fracture's stability is questionable, CT scans of displacement or stress X-rays under anaesthesia can help diagnosis.

External fixation and traction (resource limited)
Main indication Skill Equipment
Unstable pelvic ring injury without availability of posterior pelvic fixation Basic surgical experience, no specialized skills Simple surgical and imaging resources

Indications

  • Unstable pelvic injury without availability of posterior pelvic 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
  • Skeletal traction should not be applied if the involved hemipelvis is distally &/or anteriorly displaced. A circumferential wrap should be applied.

Advantages

  • Readily available
  • Low cost
  • Technically less demanding

Disadvantages

  • Prolonged bed rest
  • Less stable than internal fixation
  • Reduction may be harder to obtain and maintain
External fixation
Main indication Skill Equipment
Temporary splint for unstable pelvic ring Some specialized surgical experience Simple surgical and imaging resources

The choice between iliac crest pins and supra-acetabular pins is surgeon's preference.

Indications

  • Temporary splint for hemorrhage control
  • Definitive option for pubic ramus fractures after posterior repair
  • Intraoperative reduction aid

Contraindications

  • External fixation alone is inadequate for a completely unstable pelvic ring

Advantages

  • Rapid non-invasive application
  • Adjustable

Disadvantages

  • Pin track problems
  • Limited stability
ORIF ilium
Main indication Skill Equipment
Displaced or unstable posterior iliac fracture with unstable pelvic ring Highly experienced and skilled surgeon Simple surgical and imaging resources

Indications

  • Displaced or unstable posterior iliac fracture with unstable pelvic ring

Contraindications

  • Patient not fit for surgery
  • Local soft tissue injury

Advantages

  • Ability to provide optimal reduction and fixation
  • Shorter rehabilitation
  • Fixation may be possible with long percutaneous screws and limited exposure
*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