Pelvic Ring Injuries: Principles of Management in the Acute and Chronic Setting

Acute pelvic fractures range in severity from low energy benign lateral compression injuries to unstable patterns that require urgent resuscitation and multidisciplinary management. Multiple techniques to treat these wide variation of fracture patterns are described both in the acute and chronic settings. On the other hand, sitting imbalance is the consequence of a vertical shear fracture inadequately treated at index admission. Conventional x-rays and CT scan are very helpful to obtain an accurate diagnosis with appropriate clinical judgement; however, they do not address dynamic situations. X-rays under load or stress and the sitting imbalance view can increase the capabilities of the surgeon to understand the problem of instability, if any. Pelvic fracture surgical care is a combination of bony stabilization and soft tissue adequate handling. In the chronic setting, osteotomies are just part of the treatment. To obtain a good fragment release free of complications, anatomical knowledge is mandatory. If the deformity cannot be corrected at once, one must consider skeletal traction for one week after the release and fix the osteotomies during a second surgical session. Such injuries, either acute or chronic, are associated with potentially devastating complications including hemodynamic instability, visceral or genital injury, nerve damage, and postoperative infection.