Pelvic ring injuries: classification and treatment

Abstract

This review article will focus on the classification and treatment options for pelvic ring fractures. The pelvic ring can be split into anterior and posterior supporting structures. Injury can result in mechanical pelvic instability, the significance of which is determined by the magnitude and direction of forces applied during injury. The typical fracture patterns of anteroposterior compression, lateral compression and vertical shear form the basis of the Young and Burgess classification. However, the logic of the Tile classification system is useful in determining the degree of pelvic instability and the optimal surgical stabilization options. Posterior pelvic ring stabilization is often performed percutaneous after closed fracture reduction with sacro-iliac screws. This avoids the soft tissue complications often associated with open posterior approaches. Alternative reduction techniques can be performed through an open anterior approach using the first ilio-inguinal window to approach sacro-iliac joint disruptions as well as crescent fractures of the posterior iliac wing. The anterior pelvic ring, traditionally stabilized with external fixation, can be well accessed with the open ‘STOPPA’ approach. This allows access to an area extending from the pubic symphysis around the pelvic brim to the anterior aspect of the sacro-iliac joint where plates can be applied. Other options for anterior ring stabilization include column screws and the use of the ‘In-fix’ (Internal Fixator).