Iliac Wing Fracture Research Articles

Severe atypical iliac wing fracture associated with long-term bisphosphonate use.

Bisphosphonate use is associated with atypical non-traumatic fractures, which are most commonly seen in the femur. We report a 63-year-old postmenopausal woman who presented acutely with progressively worsening lumbar pain radiating to her left hip for 10days. There was no antecedent trauma. On examination, the patient could not bear weight on her left leg due to the severity of the pain. Radiography and computed tomography of the pelvis demonstrated an iliac wing fracture which was treated conservatively. The patient had a significant past medical history of breast cancer and intense bisphosphonate use for several years which was discontinued 3years previously. No discrete bone lesion was seen at the fracture site on computed tomography, and there was no evidence of metastatic disease elsewhere. A dual-energy X-ray absorptiometry scan showed the lowest bone mineral density T-score of - 1.2. A diagnosis of an atypical fracture related to long-term bisphosphonate therapy was made. To the best of our knowledge, this is the first reported case of an isolated iliac wing fracture associated with long-term bisphosphonate therapy in the literature. Whilst the incidence of such fractures is exceedingly rare, it is an important differential in patients with atypical fractures on long-term bisphosphonates.

Surgical management of iliac wing fractures: Proposal of a new classification system

IntroductionIsolated fractures of the iliac wing are a rare injury, usually occurring in high-energy trauma, and are associated with other non-musculoskeletal and soft tissue injuries that could compromise the patient's life. Surgical indications are unclear, and there is limited information on the most frequent fracture patterns. MethodsA descriptive multicenter case series study of isolated fractures of the iliac wing treated surgically in three referral trauma hospitals in Latin America. The different fracture patterns are described, the "iliac ring" concept is proposed, and a classification is made. ResultsTwenty-eight patients were included; 24 were male, the median age was 31 years RIQ (24–46), the most frequent trauma mechanism was a traffic accident, and in 14 patients, the ISS >16. The most frequent associated injury was to the appendicular skeleton at another level in 13 patients. In the new classification, according to the number of fragments, 11 patients were classified as type A (1 fragment), ten patients as type B (two fragments), and seven patients as type C (three or more fragments). The most compromised anatomical area was the crest and anterosuperior iliac spines in 26 patients, followed by the fossa and anteroinferior iliac spine in 17 and 8 patients, respectively. DiscussionThe patterns of isolated fractures of the iliac wing allow the identification of three types of fractures. Identifying these patterns can help the surgeon decide to perform surgery in these scenarios and choose the fixation technique according to the number and location of the fragments.

OA07 A case of severe osteoporosis treated with teriparatide following the development of bilateral atypical femoral fractures due to IV zoledronic acid

Abstract Introduction Atypical femoral fractures (AFF) are a rare complication of long-term anti-resorptive therapy. A literature review of 310 cases of AFF did reveal a median duration of bisphosphonate therapy of 7 years. Additionally, simultaneous glucocorticoid use was seen in 34% of the cases and was reported to have a 5-fold increase in one case series. Around 70% of patients do describe a prodrome of thigh pain and around quarter of all cases will have bilateral involvement. Case description A 59-year-old lady with a background diagnosis of Behçet’s disease was referred for continuation of osteoporosis care. History of Fractures 2003- left-sided distal radial fracture; 2017 - refractured again after a fall; left 5th metatarsal fracture a few months later. 2019 - right navicular fracture, left pubic rami fracture and left iliac wing fracture, after a fall from the bus In 2023, she has tripped and fell from the standing height resulting in a left femoral shaft fracture, which had radiological features of an atypical femoral fracture. She denied any prodromal thigh pain. The orthopaedic team did an intramedullary nailing to the left femoral shaft. X-ray of the right femur shaft revealed cortical thickening of right mid femoral shaft. Treatment History In 2009, she was started on oral bisphosphonate therapy and from 2020 to 2022 received 3 doses of IV zoledronic acid at the national Behçet’s centre in Birmingham. She has been on long-term steroid therapy due to the underlying Behçet's disease and was on prednisolone 7mg daily when she was referred to us. Management of AFF The orthopaedic team initially recommended a watch and wait policy for the right side; however, following discussions with the patient and with us, prophylactic nailing of the right femoral shaft was done 2 months later. Investigations DXA scan in 2022: spine T-score of−3.3 (L2 −3.6, L3 −3.9, L4 −3.7); femoral neck T-score of −2.5. Despite treatment with oral and then parenteral bisphosphonates for the last 12 years, there is a significant reduction in BMD with 18.2% decrease in the spine and 7.1% decrease in the femoral neck compared to the last DEXA in 2019. Management plan The next step was to treat her with teriparatide, which she is currently having without any problems. We shall continue it for 24 months. Discussion Atypical femoral fractures are rare. Anti-resorptive medication including bisphosphonates and denosumab are known to cause atypical femoral fractures. Teriparatide, being anabolic agent, is not associated with the increased risk of atypical femoral fractures. While there are no randomised controlled studies about the use of teriparatide in healing atypical femoral fractures, there are some case reports where teriparatide had shown improved fracture healing in AFF. After the 24 months, to ‘lock in the effects’ of teriparatide, an anti-resorptive medication will be required. Because both femoral shafts have received intramedullary nailing, we would consider IV zoledronic acid after the 24 months of teriparatide. This is the approach supported by the European Calcified Tissue Society in their systemic review and recommendations on ‘Medical Management of Patients After Atypical Femur Fractures’ (https://doi.org/10.1210/clinem/dgz295). Key learning points Consider atypical femoral fracture in patients who are on anti-resorptive therapy and complain of thigh/groin pain. Atypical femoral fractures can be bilateral; therefore, evaluate both sides. Teriparatide can be used to treat osteoporosis in patients with atypical femoral fracture, but considerations will have to be made in relation to subsequent therapy.

Development of an Injury Risk Function for the Anterior Pelvis Under Frontal Lap Belt Loading Conditions.

Iliac wing fractures due to lap belt loading have been identified in laboratory tests for almost 50years and an analysis of recent data suggests these injuries are also occurring in the field. With the introduction of highly autonomous vehicles on the horizon, vehicle manufacturers are exploring open cabin concepts that permit reclined postures and separation of the occupant from the knee bolster and instrument panel. This will result in greater reliance on the lap belt and lap belt/pelvis loading to restrain occupants. No injury criteria exist for iliac wing fractures resulting from lap belt loading like that seen in frontal crash conditions. This study tested the tolerance of isolated iliac wings in a controlled lap belt-like loading environment while incorporating the effect of loading angle after analyzing lap belt loading experiments from a previous study. Twenty-two iliac wings were tested; nineteen of them sustained fracture (exact), but the loading input was insufficient to cause fracture in the other three (right censored). The fracture tolerance of the tested specimens ranged widely (1463-8895 N) and averaged 4091 N (SD 2381 N). Injury risk functions were created by fitting Weibull survival models to data that integrated censored and exact failure observations.

V-009 Robot-Assisted Repair of a Traumatic Hernia After a Pelvic Fracture: Case Report and Literature Review

Abstract Aim Traumatic abdominal wall hernias (TAWH) are an uncommon clinical entity, accounting for less than 0.2% of all blunt trauma injuries. Management and operative technique are still a matter of debate and the role of the robotic surgical platform in traumatic hernias has not been reported on. We present a robot-assisted repair of a TAWH through a fracture of the left iliac wing. We aim to describe our operative approach and perform a review of the literature. Material and methods A 46-year-old male with a history of a high energetic trauma presented with a symptomatic swelling in the left lumbar region. Further imaging showed an important defect of the abdominal wall caused by a disruption of the iliac and gluteus muscles and non-union of a left iliac wing fracture. This caused a herniation of the descending colon. A robot-assisted transabdominal preperitoneal hernia repair (TAPP) with synthetic mesh was performed in elective setting. Results The postoperative course was uneventful. Discharge was possible at postoperative day one. There was no surgical site infection, seroma, or recurrence after a follow-up period of 6 months. Conclusions To our knowledge, we describe the first robot-assisted repair of a TAWH through a pelvic fracture. Our technique was safe and feasible. In difficult to reach areas of the abdomen, a robot-assisted repair might be a valid approach. Larger studies are needed to confirm our initial experience in traumatic abominal wall hernia surgery.

Lateral Compression Type 2 Pelvic Fractures-A Clinical Study of Fracture Displacement Measurement and Closed Reduction.

ObjectiveTo evaluate the displacement in four lateral compression type 2 (LC2) fracture subtypes (iliac wing and three kinds of crescent fractures) and to investigate the appropriate closed reduction for treatment using a pelvic reduction frame.MethodsA total of 71 patients with LC2 pelvic fractures from February 2014 to November 2019 were included in this retrospective cohort study. Preoperative X‐ray and computed tomography data were used to assess the direction of the fracture displacement and the sacroiliac joint dislocation. The fractures in all patients were reduced with a pelvic reduction frame and fixed with percutaneous screws as well as an anterior subcutaneous pelvic ring internal fixator. Two different closed reduction strategies were adopted, one was first longitudinal traction and then transverse traction, the other was first transverse traction then longitudinal and LC2 traction. The Matta score system was used to evaluate the postoperative X‐ray and the Majeed score system was used for follow‐up evaluation.ResultsA total of 13 iliac wing fractures (86.7%) and 16 Day type 1 fractures (94.1%) were vertically stable with only internal displacement, the ring width displacements were 5 (3, 8.75) and 8 (4, 12) mm, the posterior superior iliac spine (PSIS) differences were 0 (0, 0) mm and 0 (0, 0) mm. A total of 21 Day type 2 fractures (95.5%) and 16 Day type 3 fractures (94.1%) were characterized by cephalic and dorsal fracture dislocation on the basis of internal displacement, the ring width displacements were 6 (4.25, 12) and 4 (0, 7.5) mm and the PSIS differences were 4 (2, 5) and 0 (0, 3.75) mm. Based on the Matta scores, excellent reduction was achieved in 51 patients, good reduction in 17 patients, and poor reduction in three patients. The average Majeed score was 91.6, with a minimum outpatient follow‐up of 12 months (average 31.6 months).ConclusionLC2 fractures involve two different kinds of fracture displacement: internal displacement only and a combination of internal, cephalic, and dorsal dislocation through the sacroiliac joint. Good clinical outcomes can be achieved for LC2 fractures using two different closed reduction strategies.

Pelvic ring injuries after road and mountain bike accidents.

The purpose of this study was to compare patients with traumatic pelvic ring injuries sustained in road and mountain bicycling accidents to evaluate for differences in injury types and hospital courses. A retrospective review of 60 patients presenting with pelvic ring injuries after road (n = 46) and mountain (n = 14) bicycling accidents was performed to compare patient/injury characteristics and hospital course. LC1 injuries were the most common pelvic ring injury (n = 31, 51.7%), 38.7% (n = 12) of which were considered unstable, followed by isolated iliac wing (n = 11, 18.3%), pubic rami (n = 6, 10.0%), and sacral fractures (n = 6, 10.0%). Hospital admission was required for 41 (68.3%) patients. The median hospital LOS was 4days (IQR 2-9) and 12 (20%) patients received operative treatment. Patients in road versus mountain bicycling accidents were more likely to be older tobacco users and were similar in sex, body mass index, and injury severity score. Road bicycling resulted in more LC1 injuries (58.7% vs 28.6%, p = 0.04), while mountain bicycling resulted in more iliac wing fractures (42.9% vs. 10.9%, p = 0.01). Road cycling injuries required more days in the hospital to clear PT (median difference 2, CI 0-4, p = 0.04) and had longer hospital stays (median difference 2, CI 0-6, p = 0.02) but had no difference in the rate of admission, operative intervention, or discharge to rehabilitation facilities. The majority of pelvic ring injuries from road and mountain bicycling accidents were LC1 injuries that were frequently unstable and often required hospital admission and operative fixation.

Long-term results after isolated iliac wing fractures

IntroductionIsolated iliac wing fracture is a rare pelvic fracture that is considered benign in the literature. As there is a complete lack of information on function and quality of life in patients with this injury, the primary aim of this study was to evaluate the long-term functional results, and secondly to evaluate the patients’ clinical function and fracture healing. Patients and MethodsAll patients treated in Oslo University Hospital, Ullevaal (OUH-U), the Norwegian National Pelvic Service, in the time period 2006–2016 were included. Nine of 13 eligible patients (69%) were evaluated by the Patient Reported Outcome Measures (PROM); EQ-5D-3L and Majeed Score. For the secondary outcomes, the patients were clinically examined for Range of Motion (ROM) in the hips, pain, muscular function and nerve deficiencies. Finally, the patients underwent X-rays (AP-view and iliac and obturator oblique views). ResultsAll patients were injured in high-energy trauma with severe associated injuries. Five patients were operated and four received conservative treatment. At the time of follow-up (median seven years after injury), the mean EQ-5D VAS was 84, and the mean Majeed score was 87. Two out of nine reported moderate level of pain, three reported mild pain, and the rest reported no pain. Six patients were still working, two were retired, and the last one was receiving disability benefit of other reasons than the iliac fracture. One patient had difference in range of external rotation of >10° between the hips, while the rest had no differences in ROM. The follow-up X-rays showed healed fractures in all the patients. ConclusionPatients with isolated iliac wing fractures seem to have a good general state of health, scoring high on the PROMs, with minor and insignificant clinical sequela. This original finding is in accordance with the general assumption amongst pelvic surgeons that the injury is a benign one.

Pelvic ring injuries after alpine ski and snowboard accidents.

The purpose of this study was to analyze the patient/injury characteristics and associated hospital course of patients sustaining traumatic pelvic ring injuries after alpine ski and snowboard accidents at a level one trauma center in the Rocky Mountain region. Patient/injury characteristics were obtained from patients presenting with pelvic ring injuries after alpine ski (n = 55) and snowboard (n = 9) accidents. Characteristics and outcomes analyzed included mechanism of injury, pelvic ring classification (Young-Burgess and Tile), hospital admission, physical therapy (PT) clearance, ambulation, length of stay, inpatient morphine milligram equivalents (MME), and discharges to rehabilitation facility. Snowboarders were more often younger, male, tobacco/substance users, and more likely to be injured by a fall from height than skiers. There were no differences in injury classification or hospital course outcomes between alpine sports. Most common injuries included lateral compression type 1 (LC1) injuries (37.5%), isolated pubic ramus fractures (31.3%), and isolated iliac wing fractures (15.6%). LC1 injuries were unstable in 50% of cases and associated with increased admissions (proportional difference: 47.5%, CI: 23.8-64.5%, p = 0.0002), longer time to PT clearance (median difference(MD): 1.0day, CI: 0-2.0, p = 0.03), longer LOS (MD: 2.0, CI: 0-2.0, p = 0.02), and increased inpatient MMEs (MD: 197.9 MME, CI: 30.0-420.0, p = 0.02), as compared to other pelvic ring injuries. The majority of pelvic ring injuries from alpine ski and snowboard accidents were LC1 injuries, half of which were unstable, resulting in longer hospital stays, time to PT clearance/ambulation, and opioid use.

Small Bowel Entrapment Following Pelvic Fracture: A Case Report

Background: Due to traumatic events, patients with acetabular fractures are vulnerable to rupture of the peritoneum and abdominal hernia in the fracture site. Infection and thromboembolic events are the two most common complications of this situation.
 Case Report: In the current report, we present a 63 year-old woman with a traffic accident that was diagnosed with multiple fractures of posterior and anterior walls and anterior column of the right acetabulum associated with femoral head protrusion to the fracture site. Furthermore, the right posterior iliac wing fracture and mild subluxation of the right sacroiliac (SI) joint were observed in the pelvic computed tomography (CT) scan. During the Stoppa surgical approach, small intestine penetration and peritoneum were observed and immediately treated by the surgical team. Our case was later diagnosed with pulmonary thromboembolism and recovered successfully, and no infectious complications were observed.
 Conclusion: We suggest that bowel entrapment be considered in blunt traumatic events, and antibiotics and anti-coagulants be used in similar cases.

Skiver screw fixation for iliac wing fractures associated with pelvic ring fractures and acetabular fractures

Skiver screw fixation for iliac wing fractures associated with pelvic ring fractures and acetabular fractures

Osteonecrosis of the Iliac Wing and Sacral Insufficiency Fractures After Radiotherapy: Case Presentation

Osteonecrosis of the Iliac Wing and Sacral Insufficiency Fractures After Radiotherapy: Case Presentation

Primary complex total hip replacement in 13 months old neglected Pelvi-acetabular fracture

Old pelvi-acetabular fracture are very difficult to operate in terms of achievement of anatomical reduction. Although two staged procedures are still treatment of choice(first stage acetabular osteosynthesis then THR if complication occurs) but neglected cases(more than 3 weeks old untreated fractures)can also treated by total hip replacement. Our case is A 35 years old patient sustained railway traffic accident. He had crush injury left lower limb severe abdominal and chest trauma, bilateral sacroiliac join disruption, iliac wing fracture left side and pelvi-acetabular fracture right side.at that time patient was treated at other hospital where above knee amputation of left lower limb done, abdominal and chest injury managed but pelvi-acetabular fracture was treated conservatively. After 1 year patient presented to us with pain and restriction of movement of right hip and inability to sit also. we performed primary complex total hip replacement using multi-hole acetabular cup and un-cemented femoral stem with metal on ultra high molecular polyethylene bearing and bone graft. results are satisfactory with fair range of motion at hip and modfied harris hip score. So primary complex total hip replacement is viable option for old pelvi-acetabular fracture cases where anatomical and biological reduction of fracture is not possible.

Results of modified stoppa approach for anterior column acetabular fractures

Introduction: Surgical management of displaced acetabular fractures has become the gold standard after the early work of Le tournel (1–4). The choice of operative approach is dependent on the fracture type, direction of displacement, skin situation at the surgical incision site, and duration from initial injury (5–7). The fractures with the main anterior displacement are approached anteriorly, while those with the main posterior displacement are approached posteriorly. A combined or extended approach is used if the displacement involves both the anterior and posterior parts of the acetabulum. This study presents our experience of internal fixation of the acetabular fractures and pelvic fractures using a newly modified Stoppa approach, which provides closer visualization to the entire anterior column, quadrilateral surface and the pelvic brim portion of the posterior column.Materials and methods: From February 2014 to April 2016, 29 cases of acetabular fractures were treated at our institution. The inclusion criteria for this study consisted of all simple and combined acetabular fracture types with main anterior displacement. And the patients with history of cesarean section, hysterectomy, bladder injury, prostatectomy, or bladder surgery were excluded. All the patients were regularly followed in out patient department at two weeks, six weeks, three months, six months, and one year postoperatively. AP pelvic and Judet radiographs were taken and reviewed by an independent orthopaedic trauma surgeon,Results: In this study 29 patients were followed up, out of which an anatomic reduction was obtained in 24 patients (82.8 %), a satisfactory reduction in four patients (13.8 %) and poor reduction in one patient (3.4 %). All iliac wing fractures were anatomically reduced (n = 29). The Harris hip score was more than 90 points in 11 patients (37.9 %), 80–89 in 16 (55.2 %) and less than 79 in two patients (9 %).Conclusion: Our experience using of the newly modified Stoppa approach for the treatment of acetabular fractures provides excellent access and visualization to the anterior column, quadrilateral surface and sciatic notch, while permitting good to excellent reduction and fixation.

The clinical characteristics and conservative management of isolated iliac wing fractures: A single-center experience from North India

Background: The fracture of iliac bone or blade is uncommon injury and usually a part of pelvic ring disruption with varied clinical presentation. Isolated iliac bone fractures are rare, with literature limited to few reports or small series. Materials and Methods: Retrospective data of consecutive cases of isolated iliac bone fractures were analyzed during the period of July 2014 to August 2019. Relevant patient demographics, mode of injury, pattern of fracture, associated adjacent regional or remote injuries were noted for each case. Details of previous treatment and that of treatment given by us were also noted for each case. Results: A total of 18 cases with isolated iliac bone fracture of the pelvic bone were noted. The mean age was 31.2 years (range: 22–54 years). All the cases were male, and fall from height was etiology in 12 cases, followed by road traffic accidents in the rest. Left- and right-side involvement was noted in 11 and 7 cases each. The fracture pattern was minimally displaced simple in 13 and comminuted in 5 cases. The conservative management was done in all cases. The radiological union and clinical stability of fractures were assessed as end points. The fracture united in all cases within 8–9 weeks and without any immediate or remote complication. Level of evidence - Level 5, Observational Study. Conclusion: The uncommon isolated iliac wing fractures require better recognition and documentation for its management. Further studies should provide a better understanding of these injuries and treatment guidelines.

SACROPELVIC FIXATION USING ILIAC SCREWS: EVALUATION OF TECHNIQUE AND COMPLICATIONS

ABSTRACT Sacropelvic fixation arose from the need to protect the sacral instrumentation in long constructions, due to failures in the implant-bone interface and the treatment of diseases in which there is no possibilities of sacral fixation such as infections and tumors. Due to anatomic difficulties and the complex spinopelvic biomechanics several techniques were developed. The fixation with iliac screws has become according to multiple studies, a well-established technique that minimizes frequent complications such as pseudoarthrosis and implant failure. However, it has disadvantages such as iliac wing fracture and skin lesions due to the protrusion of materials. The present study aims to comprehensively review the literature on the technique taking into account relevant aspects to its better knowledge and application. Level of evidence III; Therapeutic Study.

Reference PMHS Sled Tests to Assess Submarining of the Small Female.

In the last decade, extensive efforts have been made to understand the physics of submarining and its consequences in terms of abdominal injuries. For that purpose, 27 Post Mortem Human Subject (PMHS) tests were performed in well controlled conditions on a sled and response corridors were provided to assess the biofidelity of dummies or human body models. All these efforts were based on the 50th percentile male. In parallel, efforts were initiated to transfer the understanding of submarining and the prediction criteria to the THOR dummies. Both the biofidelity targets and the criteria were scaled down from the 50th percentile male to the 5th percentile THOR female. The objective of this project was to run a set of reference PMHS tests in order to check the biofidelity of the THOR F05 in terms of submarining. Three series of tests were performed on nine PMHS, the first one was designed to avoid submarining, the second and third ones were designed to result in submarining. In the first configuration, no submarining was observed in 3 cases out of 4 and only one iliac wing fracture occurred in one subject. In the second and third configurations, all subjects but one sustained submarining. In addition, two subjects out of three in the third configuration sustained substantial iliac wing fractures. Nevertheless, all configurations can be represented by at least one or several cases without any pelvis fracture. Corridors were constructed for the external forces and the PMHS kinematics. They are provided in this paper as new experimental references to assess the biofidelity of small female human surrogates in different configurations where submarining did or did not occur.

Minimally invasive surgical treatment using 'iliac pillar' screw for isolated iliac wing fractures in geriatric patients: a new challenge.

There have been no prior case series of isolated iliac wing fracture (IIWF) due to low-energy trauma in geriatric patients in the literature. The aim of this study was to describe the characteristics of IIWF in geriatric patients, and to present a case series of IIWF in geriatric patients who underwent our minimally invasive screw fixation technique named 'iliac pillar screw fixation'. We retrospectively reviewed six geriatric patients over 65 years old who had isolated iliac wing fracture treated with minimally invasive screw fixation technique between January 2006 and April 2016. Six geriatric patients received iliac pillar screw fixation for acute IIWFs. The incidence of IIWFs was approximately 3.5% of geriatric patients with any pelvic bone fractures. The main fracture line exists in common; it extends from a point between the anterosuperior iliac spine and the anteroinferior iliac spine to a point located at the dorsal 1/3 of the iliac crest whether fracture was comminuted or not. Regarding the Koval walking ability, patients who underwent iliac pillar screw fixation technique tended to regain their pre-injury walking including one patient in a previously bedridden state. The visual analog scale score for pain at the last follow-up was quite satisfactory. Union was achieved in all patients at the last follow-up. Geriatric patients can have a form of IIWF caused by low-energy trauma that is a type of fragility fracture of the pelvis. Because subsequent deterioration of their walking status followed by a long period of non-weight bearing in geriatric patients could be as threatening as the fracture itself, the treatment paradigm for IIWF due to low-energy trauma in geriatric patients should differ from that due to high-energy trauma in most patients. In these types of fractures, minimally invasive surgical management that includes iliac pillar screw fixation can lead to good outcomes.

Blunt rupture of the thoracic duct after severe thoracic trauma

A 53-year-old man was admitted to our trauma center after sustaining thoracoabdominal injuries, secondary to a rear-end motor vehicle collision. As he stepped out of his vehicle, he was struck...

High energy pelvic ring fractures, an overview over the past decade

Intrapelvic bleeding in high energy pelvic ring fractures contributes to their high mortality. Pelvis surgical stabilization is often delayed while diagnostic tests are performed in order to exclude other injuries associated with trauma. Aim To determine which pelvic ring fractures are associated with increased mortality, whose stabilization should be considered as a priority and to determine the prognostic value of the existing pelvic ring fractures classification systems. Cohort study Selected patients admitted with high energy fracture of the pelvis in the same trauma center between 2005 and 2015. Excluded patients with hemorrhagic extra-pelvic injuries and/or previous hematologic or cardiac disease. Analyzed age, gender, trauma etiology, shock index, hemoglobin, use of pressor amines, blood transfusions plasma, angiography and vascular embolization. X-rays and CT scans were analyzed by two independent observers and fractures were classified by the following systems: Young and Burgess,Tile, Letournel (anatomic) and Denis. We analyzed the association between the different fracture patterns and the development of shock and or need of vascular embolization. Statistical analysis with IBM SPSS Statistics 20. 102 patients. Average age 43 years. Male-female 2-1. Lesional mechanism 46% running over, 32% road accident and 22% falling from heights. We found a statistically significant association between shock development, superior IGS 2 index and higher risk for embolization and the following fractured patterns–sacral fractures in Denis zone 1 ( P P P = 0.04) and Denis zone 2 ( P P P = 0.026), iliac wing fractures ( P P P P P P