Indirect Reduction of Bilateral Tilt Fractures Using a Supra-Acetabular Pelvic External Fixator

Abstract

Tilt fractures are a variant of pelvic ring fractures that result when the anterior pelvic ring is fractured at the superior pubic root and through the ischial ramus.1 Most commonly, these injuries are associated with Young and Burgess Lateral Compression type injuries. Lateral compression drives the hemipelvis medially and the resultant force allows the fragment to “tilt” anteriorly and inferiorly into the perineum. The tilt fracture is more commonly seen in women, and displacement of the ramus fragment into the perineum may result in occult open fractures. Assessment of these injuries in women requires a careful manual and speculum pelvic examination. Even without penetration of the fragment into the perineum, if left untreated, these fragments may cause dyspareunia, and therefore operative treatment is recommended. Different operative techniques have been described for surgical treatment of pubic ramus fractures.2–4 Operative treatments for tilt fractures include attempted closed reduction or open reduction and internal fixation of the anterior pelvic ring.5 We present a simple technique using a two-pin supraacetabular external fixator to indirectly reduce and maintain the tilt fracture and the pelvic ring deformity. Specifically for the treatment of tilt fractures, the fixator may be used as both a reduction and definitive fixation tool. Alternatively, the supra-acetabular fixator may be used as an intraoperative reduction tool, maintaining the reduction while definitive internal fixation is applied.