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Purpose <p>Iliac wing fractures are uncommon injuries that often result from high-energy or ballistic trauma. There are limited studies assessing injury profiles of ballistic and non-ballistic iliac wing fractures. The primary aim of this study was to evaluate injury-related characteristics and complications in patients who sustained ballistic versus non-ballistic iliac wing fractures, with the hypothesis that ballistic fractures would have higher rates of concomitant injuries and complications.</p> Methods <p>This study performed a retrospective multicenter review of patients presenting iliac wing fractures to eight Level I trauma centers between 2019 and 2024. Patients with ilium fractures and a minimum of 6-months of radiographic and clinical follow-up were included. Patients were separated into groups based on the mechanism of injury: ballistic versus non-ballistic fractures. Demographics, concomitant injuries, operative management, and complications were compared between groups.</p> Results <p>In total, 299 patients were included. There were 202 (67.6%) patients with ballistic fractures, while 97 (32.4%) had non-ballistic fractures. Patients with ballistic fractures had a significantly lower average age (25.1 vs. 43.6&#xa0;years, <i>p</i> &lt; 0.001) and injury severity score (18.1 vs. 24.1, <i>p</i> = 0.025) compared to the non-ballistic cohort. Patients with ballistic fractures also had lower rates of other pelvic fractures (25.7% vs. 40.2%, <i>p</i> = 0.015) and ipsilateral lower extremity fractures (5.0% vs. 26.8%, <i>p</i> &lt; 0.001). There were higher rates of bowel injury (58.4% vs. 14.4%, <i>p</i> &lt; 0.001) and exploratory laparotomy (68.8% vs. 17.5%, <i>p</i> &lt; 0.001) in patients with ballistic iliac wing fractures. Rates of other concomitant injuries were similar among cohorts. Patients with non-ballistic fractures had significantly higher rates of undergoing operative orthopaedic intervention (55.7% vs. 38.6%, <i>p</i> = 0.005) and necessitating internal fixation (50.5% vs. 3.0%, <i>p</i> &lt; 0.001). Cohorts had similar operative duration and estimated blood loss with surgery. Compared with the non-ballistic cohort, patients with ballistic ilium fractures had a higher incidence of infection requiring antibiotics (11.4% vs. 4.1%, <i>p</i> = 0.040) and deep infection requiring debridement of the bony pelvis (5.0% vs. 0.0%, <i>p</i> = 0.024).</p> Conclusion <p>Ballistic iliac wing fractures had high rates of bowel injury and exploratory laparotomy compared with non-ballistic fractures. Despite this, the incidence of operative orthopaedic management and internal fixation was notably higher in patients with non-ballistic fractures. Patients with ballistic fractures had higher rates of both superficial infection requiring antibiotics and deep infection requiring bony debridement. These findings suggest that ballistic iliac wing fractures less frequently result in unstable fracture patterns to the ilium, though trauma respondents should have a high index of suspicion in these ballistic fractures for concomitant abdominal injuries and subsequent infection.</p> Level of Evidence <p>Prognostic Level III.</p>

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Mechanism matters: differences in injury patterns and outcomes between ballistic and non-ballistic iliac wing fractures

  • 期刊论文

  • 发表日期：

    2026年6月1日

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  • Andrew P. Collins,
  • Genaro Ramirez-Fernandez,
  • Jessica Porras,
  • Joseph T. Patterson,
  • Nigel Blackwood,
  • Clay A. Spitler,
  • Nolan Farrell,
  • Michael J. Beebe,
  • Christian G. Falgons,
  • Jonathan G. Eastman,
  • Jennifer T. Eurich,
  • Mary Kate Erdman,
  • Zachary E. Zeller,
  • Paul Tornetta III,
  • Mir Ibrahim Sajid,
  • Hassan R. Mir,
  • Reza Firoozabadi

摘要

Purpose

Iliac wing fractures are uncommon injuries that often result from high-energy or ballistic trauma. There are limited studies assessing injury profiles of ballistic and non-ballistic iliac wing fractures. The primary aim of this study was to evaluate injury-related characteristics and complications in patients who sustained ballistic versus non-ballistic iliac wing fractures, with the hypothesis that ballistic fractures would have higher rates of concomitant injuries and complications.

Methods

This study performed a retrospective multicenter review of patients presenting iliac wing fractures to eight Level I trauma centers between 2019 and 2024. Patients with ilium fractures and a minimum of 6-months of radiographic and clinical follow-up were included. Patients were separated into groups based on the mechanism of injury: ballistic versus non-ballistic fractures. Demographics, concomitant injuries, operative management, and complications were compared between groups.

Results

In total, 299 patients were included. There were 202 (67.6%) patients with ballistic fractures, while 97 (32.4%) had non-ballistic fractures. Patients with ballistic fractures had a significantly lower average age (25.1 vs. 43.6 years, p < 0.001) and injury severity score (18.1 vs. 24.1, p = 0.025) compared to the non-ballistic cohort. Patients with ballistic fractures also had lower rates of other pelvic fractures (25.7% vs. 40.2%, p = 0.015) and ipsilateral lower extremity fractures (5.0% vs. 26.8%, p < 0.001). There were higher rates of bowel injury (58.4% vs. 14.4%, p < 0.001) and exploratory laparotomy (68.8% vs. 17.5%, p < 0.001) in patients with ballistic iliac wing fractures. Rates of other concomitant injuries were similar among cohorts. Patients with non-ballistic fractures had significantly higher rates of undergoing operative orthopaedic intervention (55.7% vs. 38.6%, p = 0.005) and necessitating internal fixation (50.5% vs. 3.0%, p < 0.001). Cohorts had similar operative duration and estimated blood loss with surgery. Compared with the non-ballistic cohort, patients with ballistic ilium fractures had a higher incidence of infection requiring antibiotics (11.4% vs. 4.1%, p = 0.040) and deep infection requiring debridement of the bony pelvis (5.0% vs. 0.0%, p = 0.024).

Conclusion

Ballistic iliac wing fractures had high rates of bowel injury and exploratory laparotomy compared with non-ballistic fractures. Despite this, the incidence of operative orthopaedic management and internal fixation was notably higher in patients with non-ballistic fractures. Patients with ballistic fractures had higher rates of both superficial infection requiring antibiotics and deep infection requiring bony debridement. These findings suggest that ballistic iliac wing fractures less frequently result in unstable fracture patterns to the ilium, though trauma respondents should have a high index of suspicion in these ballistic fractures for concomitant abdominal injuries and subsequent infection.

Level of Evidence

Prognostic Level III.