Orthopaedic management of pelvic fractures: A literature review

Abstract

Background: The incidence of pelvic fractures is increasing in many countries secondary to motor vehicle accidents and falls. It is important that the attending orthopaedic surgeon have a working system by which to classify these injuries and the Young and Burgess classification is commonly  used. The orthopaedic management of these injuries is conceptually divided into emergency room measures, interim measures, and definitive  measures. Data source: We conducted a PubMed search using keywords “Orthopaedic pelvic fractures”; “Pelvic fracture management”; “Stable pelvic fractures”; “Unstable pelvic fractures”; “External fixation pelvic fractures”; “Internal fixation pelvic fractures”; “Infix pelvic fractures”. The selection of articles included was subjective based on the discretion of the researchers. In total 36 articles were selected for inclusion in this review  which is intended to assist orthopaedic surgeons involved in the management of these injuries. Results: The mechanistic classification of Young and Burgess is not only useful to describe a pelvic fracture pattern, but furthermore reliably predicts associated intra-pelvic and extra-pelvic injuries.  Regarding emergency room management circumferential pelvic sheeting, pelvic C-clamp, and the external pelvic fixation device, are all still useful in modern emergency room pelvic fracture management. Regarding interim measures the pelvic sling, external pelvic fixation device, and more  recently the in-fix, are commonly used. In terms of definitive management complications from pin tract sepsis from prolonged application of an  external pelvic fixation device, and the complexities of open pelvic plating, have resulted in new interest in the in-fix as a definitive measure. Conclusion: While definitive open pelvic plating will always have an established role, the in-fix, with/without sacroiliac screws, is growing in popularity as an easier to perform definitive measure. Our review provides a concise overview of all the modalities currently in use, and as such is invaluable to trauma orthopaedic surgeons who will frequently need to manage this common problem.

Key words: Unstable pelvic fractures, Pelvic C-clamp, External pelvic fixator device, INFIX pelvic fixation