Skip to main content
SpringerLink
Log in

Pelvic Fractures

  • Chapter
  • First Online:
Orthopaedic Trauma Surgery

  • 328 Accesses

Abstract

Pelvic ring disruption (PRD) accounts for 3% of all adult fractures, and the majority of these cases, especially cases of irreducible, unilateral vertically displaced pelvic ring disruption (UVDPRD), requires surgical treatment (Grotz et al. 2005). Closed reduction for adult PRD is preferred over open reduction and is often achieved through transcondylar traction-based corridor screw (CS) fixation despite its flaw: A tremendous amount of caudad traction via transcondylar traction is required to reduce the cranially displaced posterior ring, but there are no good methods to resist this transcondylar traction (Thaunat et al. 2008; Lindsay et al. 2016; Ruatti et al. 2019; Abou-Khalil et al. 2020; Boudissa et al. 2020). Several tools were developed to resist the transcondylar traction, including Matta frame (Matta and Yerasimides 2007), Starr frame (Lefaivre et al. 2009a,b; Zhao et al. 2018), percutaneous Schanz screw in the greater trochanter (Elzohairy and Salama 2017), and femoral distractor (Routt Jr and Simonian 1996; Gardner and Nork 2007). However, when used with these tools, current closed reduction techniques have difficulties in achieving complete or nearly anatomical reduction of irreducible UVDPRD because hematoma maturation and soft tissue fibrosis often develop, which likely increase the risk of failed closed reduction of irreducible UVDPRD (Thaunat et al. 2008; Boudissa et al. 2020; Routt Jr and Simonian 1996; Olson and Pollak 1996). As a result, open reduction is often employed to treat irreducible UVDPRD, and an accepted closed reduction technique for irreducible UVDPRD is not established.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abou-Khalil S, Steinmetz S, Mustaki L, Leger B, Thein E, Borens O. Results of open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable pelvic ring injuries: retrospective study of 36 patients. Eur J Orthop Surg Traumatol. 2020;30(5):877–84.

    Article  PubMed  Google Scholar 

  • Aihara R, et al. Fracture locations in fl uence the likelihood of rectal and lower urinary tract injuries in patients sustaining pelvic fractures. J Trauma. 2002;52(2):205–8. discussion 208–9

    PubMed  Google Scholar 

  • Basta AM, Blackmore CC, Wessells H. Predicting urethral injury from pelvic fracture patterns in male patients with blunt trauma. J Urol. 2007;177(2):571–5.

    Article  PubMed  Google Scholar 

  • Boudissa M, Roudet A, Fumat V, et al. Part 1: outcome of posterior pelvic ring injuries and associated prognostic factors—a five-year retrospective study of one hundred and sixty five operated cases with closed reduction and percutaneous fixation. Int Orthop. 2020;44(6):1209–15.

    Article  PubMed  Google Scholar 

  • Brown CV, Kasotakis G, Wilcox A, et al. Does pelvic hematoma on admission computed tomography predict active bleeding at angiography for pelvic fracture? Am Surg. 2005;71(9):759–62.

    Article  PubMed  Google Scholar 

  • Burgess AR. External fixation. In: Tile M, editor. Fractures of the pelvis and acetabulum. 2nd ed. Baltimore: Williams & Wilkins; 1995. p. 137–49.

    Google Scholar 

  • Chen H, Zhang Q, Wu Y, Chang Z, Zhu Z, Zhang W, Tang P. Achieve Closed Reduction of Irreducible, Unilateral Vertically Displaced Pelvic Ring Disruption with an Unlocking Closed Reduction Technique. Orthop Surg. 2021 May;13(3):942–8.

    Google Scholar 

  • Conflitti JM, et al. Radiographic quantification and analysis of dysmorphic upper sacral osseous anatomy and associated Iliosacral screw insertions. J Orthop Trauma. 2010;24(10):630–6.

    Article  PubMed  Google Scholar 

  • Demetriades D, Karaiskakis M, Toutouzas K, et al. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 2002;195(1):1–10.

    Article  PubMed  Google Scholar 

  • Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;227:67–81.

    Article  CAS  PubMed  Google Scholar 

  • Dreitlein DA, Suner S, Basler J. Genitourinary trauma. Emerg Med Clin North Am. 2001;19:569–90.

    Article  CAS  PubMed  Google Scholar 

  • Dyer GS, Vrahas MS. Review of the pathophysiology and acute management of haemorrhage in pelvic fracture. Injury. 2006;37(7):602–13.

    Article  PubMed  Google Scholar 

  • Elzohairy MM, Salama AM. Open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable posterior pelvic ring disruptions. Orthop Traumatol Surg Res. 2017;103(2):223–7.

    Article  CAS  PubMed  Google Scholar 

  • Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D. Relatively short diagnostic delays (<8 hours) produce mor-bidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma. 2000;48:408–14.

    Article  CAS  PubMed  Google Scholar 

  • Gänsslen A, Pohlemann T, Paul C, et al. Epidemiology of pelvic ring injuries. Injury. 1996;27 Suppl 1:S-A13–20.

    Article  Google Scholar 

  • Ganz R, Krushell RJ, Jakob RP, et al. The antishock pelvic clamp. Clin Orthop. 1991;267:71–8.

    Article  Google Scholar 

  • Gardner MJ, Nork SE. Stabilization of unstable pelvic fractures with supraacetabular compression external fixation. J Orthop Trauma. 2007;21(4):269–73.

    Article  PubMed  Google Scholar 

  • Gardner MJ, et al. Quantification of the upper and second sacral segment safe zones in Normal and dysmorphic sacra. J Orthop Trauma. 2010;24(10):622–9.

    Article  PubMed  Google Scholar 

  • Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury. 2004;35(7):671–7.

    Article  CAS  PubMed  Google Scholar 

  • Giannoudis PV, et al. Percutaneous fixation of the pelvic ring an update. J Bone Joint Surg (Br). 2007;89-B:145–54.

    Article  Google Scholar 

  • Gibbons KJ, Soloniuk DS, Razack N. Neurological injury and patterns of sacral fractures. J Neurosurg. 1990;72(6):889–93.

    Article  CAS  PubMed  Google Scholar 

  • Gomez RG, Ceballos L, Coburn M, Corriere JN Jr, Dixon CM, Lobel B, et al. Consensus statement on bladder injuries. BJU Int. 2004;94:27–32.

    Article  PubMed  Google Scholar 

  • Gonzalez RP, Fried PQ, Bukhalo M. The utility of clinical examination in screening for pelvic fractures in blunt trauma. J Am Coll Surg. 2002;194(2):121–5.

    Article  PubMed  Google Scholar 

  • Gribnau AJG, et al. U-shaped sacral fractures: surgical treatment and quality of life. Injury. 2009;40:1040–8.

    Article  CAS  PubMed  Google Scholar 

  • Griffin DR, Starr AJ, Reinert CM, Jones AL, Whitlock S. Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure. J Orthop Trauma. 2003;17(6):399–405.

    Article  PubMed  Google Scholar 

  • Grotz MR, Allami MK, Harwood P, et al. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury. 2005;36(1):1–13.

    Article  CAS  PubMed  Google Scholar 

  • Kardong KV. Vertebrates: comparative anatomy, function, evolution. 6th ed. New York: McGraw-Hill; 2012. p. p354.

    Google Scholar 

  • Khaled SA, Soliman O, Wahed MA. Functional outcome ofunstable pelvic ring injuries after iliosacral screw fixation: single versus two screw fixation. Eur J Trauma Emerg Surg. 2015;41(4):387–92.

    Article  CAS  PubMed  Google Scholar 

  • Kregor PJ, Routt ML. Unstable pelvic ring disruptions in unstable patients. Injury. 1999;30(suppl 2):SB19-SB28.

    Google Scholar 

  • Lefaivre KA, Starr AJ, Barker BP, Overturf S, Reinert CM. Early experience with reduction of displaced disruption of the pelvic ring using a pelvic reduction frame. J Bone Joint Surg (Br). 2009a;91(9):1201–7.

    Article  CAS  PubMed  Google Scholar 

  • Lefaivre KA, Starr AJ, Reinert CM. Reduction of displaced pelvic ring disruptions using a pelvic reduction frame. J Orthop Trauma. 2009b;23(4):299–308.

    Article  PubMed  Google Scholar 

  • Lindsay A, Tornetta P 3rd, Diwan A, Templeman D. Is closed reduction and percutaneous fixation of unstable posterior ring injuries as accurate as open reduction and internal fixation. J Orthop Trauma. 2016;30(1):29–33.

    Article  PubMed  Google Scholar 

  • Luo Y, Chen H, He L, Yi C. Displaced posterior pelvic ring fractures treated with an unlocking closed reduction technique: Prognostic factors associated with closed reduction failure, reduction quality, and fixation failure. Injury. 2022:S0020-1383(22)00001-8.

    Google Scholar 

  • Lynch TH, Martinez-Pineiro L, Plas E, Serafetinides E, Türkeri L, Santucci RA, et al. EAU guidelines on urological trauma. Eur Urol. 2005;47:1–15.

    Article  PubMed  Google Scholar 

  • Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br). 1989;71(2):304–6.

    Article  CAS  PubMed  Google Scholar 

  • Marvin Tile MD. Acute pelvic fractures: II. Principles of management. J Am Acad Orthop Surg. 1996a;4(3):152–61.

    Article  Google Scholar 

  • Marvin Tile MD. Acute pelvic fractures: I. causation and classification. J Am Acad Orthop Surg. 1996b;4(3):143–51.

    Article  Google Scholar 

  • Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res. 1996;329:129–40.

    Article  Google Scholar 

  • Matta JM, Yerasimides JG. Table-skeletal fixation as an adjunct to pelvic ring reduction. J Orthop Trauma. 2007;21(9):647–56.

    Article  PubMed  Google Scholar 

  • McCormack R, et al. Diagnosis and Management of Pelvic Fractures. Bull NYU Hosp Jt Dis. 2010;68(4):281–91.

    PubMed  Google Scholar 

  • Mohanty K, Musso D, Powell JN, et al. Emergent management of pelvic ring injuries: an update. Can J Surg. 2005;48(1):49–56.

    PubMed  PubMed Central  Google Scholar 

  • Niederee MJ, Byrnes MC, Helmer SD, Smith RS. Delay in diagnosis of hollow viscus injuries: effect on outcome. Am Surg. 2003;69:293–8.

    Article  PubMed  Google Scholar 

  • Nunn T, Cosker TD, Bose D, Pallister I. Immediate application of improvised pelvic binder as first step in extended resuscitation from life-threatening hypovolaemic shock in conscious patients with unstable pelvic injuries. Injury. 2007;38(1):125–8. Epub, 2006 Sep 22

    Article  PubMed  Google Scholar 

  • Olson SA, Pollak AN. Assessment of pelvic ring stability after injury. Indications for surgical stabilization. Clin Orthop Relat Res. 1996;329:15–27.

    Article  Google Scholar 

  • Pape H-C, et al. The poly-traumatized patient with fractures a multi-disciplinary approach. Berlin Heidelberg: Springer-Verlag; 2011. p. 119.

    Book  Google Scholar 

  • Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop Relat Res. 1980;151:12–21.

    Google Scholar 

  • Perry JF Jr. Pelvic open fractures. Clin Orthop Relat Res. 1980;151:41–5.

    Google Scholar 

  • Reilly MC, et al. The effect of sacral fracture malreduction on the safe placement of iliosacral screws. J Orthop Trauma. 2003;17(2):88–94.

    Article  PubMed  Google Scholar 

  • Routt ML Jr, Simonian PT. Closed reduction and percutaneous skeletal fixation of sacral fractures. Clin Orthop Relat Res. 1996;329:121–8.

    Article  Google Scholar 

  • Routt ML Jr, Simonian PT, Ballmer F. A rational approach to pelvic trauma: resuscitation and early definitive stabilization. Clin Orthop. 1995;318:61–74.

    Google Scholar 

  • Routt ML Jr, Simonian PT, Agnew SG, Mann FA. Radiographic recognition of the sacral alar slope for optimal placement of iliosacral screws: a cadaveric and clinical study. J Orthop Trauma. 1996;10:171–7.

    Article  PubMed  Google Scholar 

  • Routt ML Jr, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma. 1997;11:584–9.

    Article  PubMed  Google Scholar 

  • Routt ML Jr, Nork SE, Mills WJ. Percutaneous fixation of pelvic ring disruptions. Clin Orthop. 2000;375:15–29.

    Article  Google Scholar 

  • Routt MLC, Simonian PT, Inaba J. Iliosacral screw fixation of the disrupted sacroiliac joint. Tech Orthop. 1994;9:300–14.

    Article  Google Scholar 

  • Ruatti S, Boudissa M, Kerschbaumer G, Milaire M, Tonetti J. Effectiveness of closed reduction and percutaneous fixation of isolated sacral fractures. Functional outcomes and sagittal alignment after 3.6 years in 20 patients. Orthop Traumatol Surg Res. 2019;105(4):719–25.

    Article  PubMed  Google Scholar 

  • Templeman D, et al. Internal fi xation of displaced fractures of the sacrum. Clin Orthop Relat Res. 1996;329:180–5.

    Article  Google Scholar 

  • Thaunat M, Laude F, Paillard P, Saillant G, Catonné Y. Transcondylar traction as a closed reduction technique in vertically unstable pelvic ring disruption. Int Orthop. 2008;32(1):7–12.

    Article  CAS  PubMed  Google Scholar 

  • Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg (Br). 1988;70(1):1–12.

    CAS  PubMed  Google Scholar 

  • Tonetti J, Carrat L, Lavalleé S, et al. Percutaneous iliosacral screw placement using image guided techniques. Clin Orthop. 1998;354:103–10.

    Article  Google Scholar 

  • Vaccaro AR, Kim DH, Brodke DS, et al. Diagnosis and management of sacral spine fractures. Instr Course Lect. 2004;53:375–85.

    PubMed  Google Scholar 

  • Van den Bosch EW, Van Zwienen CM, Van Vugt AB. Fluoroscopic positioning of sacroiliac screws in 88 patients. J Trauma. 2002;53:44–8.

    Article  PubMed  Google Scholar 

  • van Zwienen CM, et al. Biomechanical comparison of sacroiliac screw techniques for unstable pelvic ring fractures. J Orthop Trauma. 2004;18(9):589–95.

    Article  PubMed  Google Scholar 

  • Vrahas M, Hearn TC, Diangelo D, et al. Ligamentous contributions to pelvic stability. Orthopedics. 1995;18:271–4.

    Article  CAS  PubMed  Google Scholar 

  • Wu Y, Chen H, Zhou X, Tang P. Lateral Compression Type 2 Pelvic Fractures-A Clinical Study of Fracture Displacement Measurement and Closed Reduction. Orthop Surg. 2022;14(10):2545–52.

    Google Scholar 

  • Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160(2):445–51.

    Article  CAS  PubMed  Google Scholar 

  • Zhao JX, Zhang LC, Su XY, et al. Early experience with reduction of unstable pelvic fracture using a computer-aided reduction frame. Biomed Res Int. 2018;2018:7297635.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chinese PLA General Hospital, Beijing, China

    Peifu Tang, Hua Chen & Yan Wu

  2. Beijing Tsinghua Changgung Hospital, Beijing, China

    Zhe Zhao

Authors
  1. Peifu Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hua Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhe Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China

    Peifu Tang

  2. Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China

    Hua Chen

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tang, P., Chen, H., Zhao, Z., Wu, Y. (2023). Pelvic Fractures. In: Tang, P., Chen, H. (eds) Orthopaedic Trauma Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-16-0219-1_3

Download citation

  • DOI: https://doi.org/10.1007/978-981-16-0219-1_3

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-16-0218-4

  • Online ISBN: 978-981-16-0219-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation