Pelvic Disruption: Principles of Management

Author summary

Proper treatment of pelvic injuries requires careful assessment of the type of displacement (based on the mechanism of force) and the degree of stability of the hemipelvis. Open-book type AP compression fractures of the pelvis can be treated by simple reduction followed by immobilization in a pelvic sling, plaster spica, or with external fixators. The lateral compression fractures all produce some degree of inward rotation of the hemipelvis and often reduce spontaneously while in the supine position but may require external rotation forces to reduce the fracture. Complete bed rest with traction through a supracondylar femoral pin or with external fixators are the recommended means of immobilization. Vertical shear fractures are easily reduced with traction through a supracondylar pin or with external fixators. Maintaining reduction is difficult, however, and these fracture types often require long periods of immobilization due to their high degree of instability. Open reduction may be indicated for vertical shear fractures when adequate reduction cannot be maintained by way of closed reduction or external fixators. Associated acetabular fracture is another indication for open reduction in these cases. Pelvic fractures must be assessed and treated quickly in order to avoid further complications or difficulties in treatment.