Pelvic ring injuries: recent advances in diagnosis and treatment

Abstract

Pelvic ring injuries typically occur from high-energy trauma and are often associated with multisystem injuries. Prompt diagnosis of pelvic ring injuries is essential, and timely initial management is critical in the early resuscitation of polytraumatized patients. Definitive management of pelvic ring injuries continues to be a topic of much debate in the trauma community. Recent studies continue to inform our understanding of static and dynamic pelvic ring stability. Furthermore, literature investigating radiographic and clinical outcomes after nonoperative and operative management will help guide trauma surgeons select the most appropriate treatment of patients with these injuries.

Keywords: acetabulum; pelvic ring; pelvis.

Figure 1.

Tile—AO/OTA pelvic fracture classification.

Figure 2.

Pelvic examination under anesthesia. Reproduced with permission from Avilucea FR, Archdeacon MT, Collinge CA, Sciadini M, Sagi HC, Mir HR. Fixation strategy using sequential intraoperative examination under anesthesia for unstable lateral compression pelvic ring injuries reliably predicts union with minimal displacement. J Bone Joint Surg Am. 2018; 100(17):1503–1508. https://doi.org/10.2106/JBJS.17.01650.

Figure 3.

A, Preoperative 3D reconstruction of a complex unstable pelvic ring injury involving bilateral superior and inferior rami, iliac wing, sacroiliac, and sacrum fractures. B, Postoperative AP radiograph showing definitive fixation. Bilateral ramus fractures are fixed with a retrograde partially threaded screw on the right and an antegrade partially threaded screw on the left. Both ilium fractures are fixed with a combination of screws and plates for the iliac wing and plates for the pelvic brims. The bilateral SI joint injuries and sacral fractures are fixed with oblique sacroiliac screws at the upper sacral segment and a transverse, transsacral-transiliac screw at the second sacral segment.