Executive Editor: Peter Trafton

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

Pelvic ring

back to skeleton

Glossary

Primary survey

Please select a treatment option:
Treatment Main indication Skill Equipment
Airway ATLS step number 1 Some specialized surgical experience Basic equipment only
Breathing ATLS step number 2 Some specialized surgical experience Basic equipment only
Circulation ATLS step number 3 Some specialized surgical experience Basic equipment only
Disability ATLS step number 4 Some specialized surgical experience Basic equipment only
Exposure and environmental control ATLS step number 5 Some specialized surgical experience Basic equipment only

Secondary survey

Please select a treatment option:
Treatment Main indication Skill Equipment
Secondary survey Injured patient with possible pelvic injury and/or hemodynamic instability Some specialized surgical experience Basic equipment only

Acute pelvic treatment

Please select a treatment option:
Treatment Main indication Skill Equipment
Extraperitoneal pelvic packing Unstable pelvis, hemodynamic instability, unresponsive to resuscitation Highly experienced and skilled surgeon Basic equipment only
Angio embolization Hemodynamically unstable patient, especially with arterial bleeding Highly experienced and skilled surgeon Full specialized surgical and imaging resources
External fixation: Emergency stabilization with a C-clamp Mechanically unstable pelvic ring without obvious innominate bone comminution or fracture line at pin site Highly experienced and skilled surgeon Full specialized surgical and imaging resources
External fixation Unstable pelvis with hemodynamic instability Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Intact posterior arch, innominate bone avulsion fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Acceptable displacement Basic surgical experience, no specialized skills Basic equipment only
ORIF - apophyseal avulsion fracture Gross displacement Some specialized surgical experience Basic equipment only

Intact posterior arch, innominate bone, Iliac wing fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Acceptable deformity and displacement Basic surgical experience, no specialized skills Basic equipment only
ORIF - iliac crest Large fragment with significant displacement Some specialized surgical experience Simple surgical and imaging resources

Intact posterior arch, uni- or bilateral fracture anterior arch

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Acceptable fracture deformity Basic surgical experience, no specialized skills Basic equipment only
ORIF - Pubic symphysis plate Significant symphyseal displacement Some specialized surgical experience Simple surgical and imaging resources
ORIF - Pubic ramus plate Significant displacement Some specialized surgical experience Simple surgical and imaging resources
ORIF - Pubic ramus screw Significant displacement Some specialized surgical experience Simple surgical and imaging resources

Intact posterior arch, sacrococcygeal dislocation

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Almost all coccygeal dislocations Basic surgical experience, no specialized skills Basic equipment only

Intact posterior arch, unidsplaced transverse sacral fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Essentially all undisplaced transverse sacral fractures Basic surgical experience, no specialized skills Basic equipment only

Intact posterior arch, displaced transverse sacral fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Displaced distal sacral fractures without indications for surgery Basic surgical experience, no specialized skills Basic equipment only
ORIF Plate Associated sacral plexus nerve root deficit Basic surgical experience, no specialized skills Basic equipment only

Incomplete disruption posterior arch, open book injury

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Minimally displaced, stable injury Basic surgical experience, no specialized skills Basic equipment only
External fixation and traction Unstable open book injury and cranial displacement Some specialized surgical experience Basic equipment only
Operative treatment Unstable open book injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Incomplete disruption posterior arch, lateral compression fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonperative Stable injuries with acceptable deformity Basic surgical experience, no specialized skills Basic equipment only
External fixation and traction Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
External fixation Significant internal rotation deformity or lower extremity shortening Highly experienced and skilled surgeon Simple surgical and imaging resources
Operative treatment Significant internal rotation deformity; symphyseal disruption Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Incomplete disruption posterior arch, bilateral injury

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Minimally displaced, stable injuries Basic surgical experience, no specialized skills Basic equipment only
External fixation and traction Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
Operative treatment Pelvic deformity; symphyseal disruption Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Unilateral complete distruption posterior arch through ilium

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
Operative treatment All unilateral complete distruption injuries of the posterior arch through the ilium Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Unilateral complete distruption posterior arch through SI joint

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
Operative treatment All unilateral complete distruption injuries of the posterior arch through the SI joint Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Unilateral complete distruption posterior arch through Sacrum

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
Operative treatment All unilateral complete distruption injuries of the posterior arch through the sacrum; nerve root involvement Some specialized surgical experience Full specialized surgical and imaging resources

Unilateral complete, contralateral incomplete disruption of posterior arch

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
Operative treatment All unilateral complete, contralateral incomplete disruption of posterior arch injuries Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Bilateral complete disruption of posterior arch

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction Unstable pelvic injury without availability of posterior ring fixation Some specialized surgical experience Basic equipment only
Operative treatment All bilateral complete disruption of posterior arch injuries Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Sacral fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction Unstable pelvic ring injury without availability of posterior pelvic fixation Basic surgical experience, no specialized skills Simple surgical and imaging resources
External fixation Temporary splint for unstable pelvic ring Some specialized surgical experience Simple surgical and imaging resources
ORIF - Sacrum Displaced unstable sacral fracture and nerve root injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Iliosacral screw for sacrum Well aligned, unstable sacral alar fracture; neurologically intact Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Iliosacral screw navigation Well aligned, unstable sacral alar fracture; navigation technology available Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Triangular osteosynthesis Vertically unstable transforaminal sacral fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Ilioiliac plate Displaced, unstable sacral alar fractures, especially bilateral Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Spinopelvic fixation Transverse central sacral fracture, displaced or unstable; nerve root injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

SI-joint fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction Unstable pelvic ring injury without availability of posterior pelvic fixation Basic surgical experience, no specialized skills Simple surgical and imaging resources
External fixation Temporary splint for unstable pelvic ring Some specialized surgical experience Simple surgical and imaging resources
ORIF - Anterior SI fracture fixation Anterior open reduction of SI and fracture fixation Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Posterior SI fracture fixation Posterior open reduction of SI and fracture fixation Highly experienced and skilled surgeon Simple surgical and imaging resources
MIO - Iliosacral screw for sacrum Unstable SI joint, satisfactorily reduced Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Iliosacral screw navigation Unstable SI joint, satisfactorily reduced; same as for standard C-arm technique Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Anterior fixation SI Joint Inability to gain closed reduction of SI joint Highly experienced and skilled surgeon Simple surgical and imaging resources

Iliac fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation and traction (resource limited) Unstable pelvic ring injury without availability of posterior pelvic fixation Basic surgical experience, no specialized skills Simple surgical and imaging resources
External fixation Temporary splint for unstable pelvic ring Some specialized surgical experience Simple surgical and imaging resources
ORIF - ilium Displaced or unstable posterior iliac fracture with unstable pelvic ring Highly experienced and skilled surgeon Simple surgical and imaging resources

Pubic ramus fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Stable undisplaced pubic ramus fracture Basic surgical experience, no specialized skills Basic equipment only
External fixation Displaced pubic ramus fractures with unstable pelvic ring Some specialized surgical experience Simple surgical and imaging resources
ORIF - Pubic ramus plate Part of combined anterior and posterior fixation for unstable pelvic ring Some specialized surgical experience Simple surgical and imaging resources
ORIF - Pubic ramus screw Alternative to plate fixation of unstable ramus fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Pubic symphysis fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
ORIF - Pubic symphysis plate Pubic symphysis disruption with partial or complete pelvic ring instability Highly experienced and skilled surgeon Simple surgical and imaging resources

Stable ring fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Most closed stable ring fractures without gross deformity or displacement Basic surgical experience, no specialized skills Simple surgical and imaging resources
ORIF - Apophyseal avulsion fracture Significantly displaced apophyseal fractures Some specialized surgical experience Simple surgical and imaging resources
ORIF - Iliac crest Large displaced iliac wing fracture Some specialized surgical experience Simple surgical and imaging resources
ORIF - Sacrum Associated sacral plexus nerve root deficit Highly experienced and skilled surgeon Simple surgical and imaging resources
*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