Pelvic Fracture Failed Fixation

Pelvic ring malunions and non-unions can be debilitating for patients and extremely challenging for the surgeon to manage. Even in the best of situations it is difficult to obtain an excellent outcome. Detailed workup of the patient must be performed to identify all modifiable and non-modifiable risk factors. Careful analysis of all imaging is necessary to understand which treatment options and fixation strategies may be of benefit, and which may cause undue harm to the patient. With all of these data gathered and analyzed the surgeon can carefully plan a surgical intervention that will mitigate risk of complication while allowing for healing of the pelvic ring non-union. In this chapter the workup and management of a morbidly obese male with catastrophic hardware failure resulting in a painful pelvic ring non-union is detailed. It starts with a careful history followed by critical analysis of all lab work and identifies all patient risk factors to determine what can be modifiable prior to surgical intervention. Preferred imaging is reviewed to evaluate for subtle details of the pelvic ring injury. Once all patient factors and imaging are reviewed, only then the different treatment options can be efficiently assessed to determine which will provide the right balance of risk mitigation and fracture fixation. After taking all these factors into account, a treatment strategy was devised and executed to repair the pelvic non-union in this patient. With thoughtfulness and meticulous planning the pelvic ring went on to heal and the patient was able to have an excellent outcome and return back to pre-injury levels of activity and work.