Executive Editor: Peter Trafton

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

Pelvic ring - Stable ring

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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.

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

In most cases, non-operative treatment is sufficient for stable ring injuries. The only exception is transverse sacral fractures with nerve root involvement.

Nonoperative
Main indication Skill Equipment
Most closed Type A fractures without gross deformity or displacement Basic surgical experience, no specialized skills Simple surgical and imaging resources

Indications

  • Apophyseal avulsion fractures (Type A1) without gross displacement or significant functional limitations
  • Transverse iliac wing fractures (Type A2) which are small and/or minimally displaced
  • Pubic ramus fractures due to direct frontal blow, without sign of posterior arch injury
  • Transverse sacral fractures (Type A3) which are closed and have acceptable deformity

Contraindications

  • Open fracture
  • Significant displacement or deformity

Advantages

  • No surgical risk

Disadvantages

  • Possibility of delayed displacement
  • Possible functional impairment
ORIF; apophyseal avulsion fracture
Main indication Skill Equipment
Significantly displaced apophyseal fractures Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Significant displacements; obvious deformity
  • High demand patients (active athletes)

Advantages

  • Potentially more effective correction of deformity
  • Faster relief of pain and rehabilitation

Disadvantages

  • Possibility of persisting pain and deformity
  • Possible need for screw removal
ORIF; iliac crest
Main indication Skill Equipment
Large displaced A2 iliac wing fracture Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Large displaced A2 iliac wing fracture
  • Presence or possibility of unacceptable pelvic deformity
  • Open fracture with fragment instability

Advantages

  • Correction of deformity and increased comfort
  • More rapid return to activities

Disadvantages

  • Possibility of redisplacement
  • May not prevent persistent pain
ORIF sacrum
Main indication Skill Equipment
Associated sacral plexus nerve root deficit Highly experienced and skilled surgeon Simple surgical and imaging resources

Indications

  • Associated sacral plexus nerve root deficit
  • Severe local deformity
  • Open fracture
*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