The value of external fixation for unstable pelvic ring injuries

Unstable pelvic ring injuries are severe injuries, with high morbidity and mortality rates. Since 1994, the authors have been using external fixation to treat these injuries. They present the results achieved in a series of 22 cases of unstable pelvic ring injuries admitted to their institution between 1994 and 2001. External fixation was performed in all cases with pins inserted between the anterior superior and the anterior inferior iliac spine. Posterior injuries were treated operatively in four cases and non-operatively in others. The average age of the patients was 32 years (range: 22 to 56 years). According to Tile's classification, there were 10 type B and 12 type C injuries. Functional evaluation using Majeed's score at the time of review showed a mean score of 75.6 (range: 12-100). The pain score was 22.7/30. Radiological results were good in horizontal injuries, with satisfactory reduction of the symphyseal disruption. In vertical shear injuries however, skeletal traction alone did not achieve accurate posterior reduction in four cases, in which internal fixation was required. Anteroinferior placement of external fixation pins appears as a safe technique with a potential for increased stability of fixation. Associated posterior injuries must be treated with direct internal fixation in cases with vertical instability in which heavy skeletal traction has failed to achieve reduction.