1 Introduction topenlarge
Pure iliac crest fractures do not compromise the stability of the pelvic ring and are mainly treated conservatively.
Open reduction and fixation is normally performed in cases when:
- persistent pain (does not subside within 1-3 weeks)
- X-rays show increasing displacement
- there is significant displacement in active and healthy patients
Great care should be taken to exclude acetabular fractures and unstable pelvic injuries.
The anterior approach to the iliac wing is used. However, stripping of muscles should be kept to a minimum.
2 Reduction topenlarge
Reduction is performed under direct vision using either a reduction forceps or Schanz screws as joysticks.
In comminuted fractures, anatomic reduction is not necessary. The basic shape of the iliac wing should be reconstructed.
Temporary fixation is obtained by insertion of K-wires.
3 Fixation topenlarge
A 3.5 mm reconstruction plate is contoured to fit the individual anatomy of the superior part of the iliac crest (green dotted line).
The bone stock of the central fossa is too thin to allow for adequate purchase of screws.
The plate is placed and fixed with screws.
Alternatively, long 3.5 mm screws placed between the tables of the superior ala can be used. These trans-iliac screws can be further supplemented with plate fixation.
After completion of internal fixation, confirm the final reduction and hardware position intraoperatively by AP, inlet and outlet radiographic imaging.