Definitive Management Option of Pelvic Ring Injury

Mohammad Zaim Chilmi, Ismail Hadisoebroto Dilogo


Pelvic ring injury is a rare condition with the incidence of hip fracture about 3% to 8% of all fractures. However, the majority of pelvic fracture patients have a high morbidity rate that could threaten their survival. The majority cause of hip fracture is high energy blunt trauma and is related to polytrauma incident.  The main goals of management for pelvic ring injury are to restore the form and stability of the pelvic. The main goal is to prevent nonunion and malunion, which lead to chronic pain and disability.


This review is focused on the strengths and weaknesses of the management option, approach and complication for pelvic ring fracture surgery. Complications of pelvic ring fracture surgery are bleeding, nerve damage, DVT, pulmonary embolism, soft tissue injury, sepsis, and malunion of the pelvis and nonunion. Management for pelvic ring fracture surgery is used based on the location and configuration of the fracture, implant availability, surgeon’s preference, and experience.


Pelvic Ring Fracture; Pelvic Ring Injuries; Approaches Pelvic Fracture; Management Pelvic Fracture;

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Halawi MJ. Pelvic ring injuries: Surgical management and long-term outcomes. J Clin Orthop Trauma [Internet]. 2016;7(1):1–6.

Cole PA, Gauger EM, Anavian J, Ly T V., Morgan RA, Heddings AA. Anterior pelvic external fixator versus subcutaneous internal fixator in the treatment of anterior ring pelvic fractures. J Orthop Trauma. 2012;26(5):269–77.

Banierink H, Reininga IHF, Heineman E, Wendt KW, ten Duis K, IJpma FFA. Long-term physical functioning and quality of life after pelvic ring injuries. Arch Orthop Trauma Surg. 2019;139(9):1225–33.

Mostafa AMHAM, Kyriacou H, Chimutengwende-Gordon M, Khan WS. An overview of the key principles and guidelines in the management of pelvic fractures. J Perioper Pract. 2020;

Gordon WT, Fleming ME, Johnson AE, Gurney J, Shackelford S, Stockinger ZT. Pelvic fracture care. Mil Med. 2018;183:115–7.

Langford JR, Burgess AR, Liporace FA, Haidukewych GJ. Pelvic fractures: part 1. Evaluation, classification, and resuscitation. J Am Acad Orthop Surg. 2013 Aug;21(8):448–57.

Lindahl J, Hirvensalo E. Surgical treatment of pelvic ring fractures. 2008;31:42–7.

Isler B, Ganz R. Classification of pelvic ring injuries. Injury. 1996;27 Suppl 1:S-A3-12.

Küper MA, Trulson A, Stuby FM, Stöckle U. Pelvic ring fractures in the elderly. EFORT Open Rev. 2019;4(6):313–20.

Witvliet MJ, Ping Fung Kon Jin PH, Goslings JC, Luitse JS, Ponsen KJ. Historical treatment results of pelvic ring fractures: A 12-year cohort study. Eur J Trauma Emerg Surg. 2009;35(1):43–8.

Langford JR, Burgess AR, Liporace FA, Haidukewych GJ. Pelvic fractures: part 2. Contemporary indications and techniques for definitive surgical management. J Am Acad Orthop Surg. 2013 Aug;21(8):458–68.

Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg [Internet]. 2017;12(1):1–18.

Gray A, Chandler H, Sabri O. Pelvic ring injuries: classification and treatment. Orthop Trauma. 2018;32(2):80–90.

Ismail HD, Lubis MF, Djaja YP. The outcome of complex pelvic fracture after internal fixation surgery. Malaysian Orthop J. 2016;10(1):16–21.

Lee C, Sciadini M. The Use of External Fixation for the Management of the Unstable Anterior Pelvic Ring. J Orthop Trauma. 2018 Sep;32 Suppl 6:S14–7.

Marecek GS, Scolaro JA. Anterior Pelvic Ring: Introduction to Evaluation and Management. J Orthop Trauma. 2018;32(9):8–10.

Wong JML, Bucknill A. Fractures of the pelvic ring. Injury. 2017;48(4):795–802.

Moon DH, Kim NK, Won JS, Choi JS, Kim DH. Outcome of Surgical Treatment of AO Type C Pelvic Ring Injury. Hip Pelvis. 2014;26(4):269.

Mcdonald E, Theologis AA, Horst P, Kandemir U, Pekmezci M. When do anterior external or internal fixators provide additional stability in an unstable (Tile C) pelvic fracture? A biomechanical study. Eur J Trauma Emerg Surg. 2015;41(6):665–71.

Iorio JA, Jakoi AM, Rehman S. Percutaneous Sacroiliac Screw Fixation of the Posterior Pelvic Ring. Orthop Clin North Am. 2015 Oct;46(4):511–21.

Tile M, Helfet DL, Kellam JF, Vrahas M. Fractures of the Pelvis and Acetabulum - Principles and Methods of Management. Fourth Edi. AO Foundation, Clavadelerstrasse 8, 7270 Davos Platz S, editor. Georg Thieme Verlag, Rüdigerstrasse 14, 70469 Stuttgart, Germany, and Thieme New York, 333 Seventh Avenue, New York, NY 10001, USA; 2015.

Becker SC, Holstein JH, Pizanis A, Pohlemann T. [Anterior approaches to the pelvic ring]. Unfallchirurg. 2013 Mar;116(3):198–204.

Oh HK, Choo SK, Kim JJ, Lee M. Stoppa approach for anterior plate fixation in unstable pelvic ring injury. CiOS Clin Orthop Surg. 2016;8(3):243–8.

Wu H, Zhang L, Guo X, Jiang X. Meta-analysis of modified Stoppa approach and ilioinguinal approach in anterior pelvic ring and acetabular fractures. Med (United States). 2020;99(4).

Tosounidis TH, Giannoudis VP, Kanakaris NK, Giannoudis P V. The Ilioinguinal Approach. JBJS Essent Surg Tech. 2018;8(2):e19.

Fensky F, Lehmann W, Ruecker A, Rueger JM. Ilioinguinal Approach: Indication and Technique. J Orthop Trauma. 2018 Aug;32 Suppl 1:S12–3.

Ismail HD, Djaja YP, Fiolin J. Minimally invasive plate osteosynthesis on anterior pelvic ring injury and anterior column acetabular fracture. J Clin Orthop Trauma [Internet]. 2017;8(3):232–40.

Kalia R, Agrawal A. Surgical approaches of the pelvis. J Orthop Traumatol Rehabil. 2014;7(1):14.

Li P, Zhou D, Fu B, Song W, Dong J. Management and outcome of pelvic fracture associated with vaginal injuries: A retrospective study of 25 cases. BMC Musculoskelet Disord. 2019;20(1):1–7.

Suzuki T, Shindo M, Soma K, Minehara H, Nakamura K, Uchino M, et al. Long-term functional outcome after unstable pelvic ring fracture. J Trauma. 2007 Oct;63(4):884–8.



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