[Anterior approaches to the pelvic ring]

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Anatomy

Context:

• Anterior pelvic ring stabilization techniques were standard before minimally invasive methods.
• Anterior approaches are vital for complex trauma requiring supine positioning.
• Increasing use in elderly patients with osteoporotic pelvic fractures.

Purpose:

• To review the relevance and application of anterior surgical approaches for pelvic ring stabilization.
• To detail various anterior approaches for different types of pelvic ring fractures and instabilities.
• To emphasize the importance of anatomical knowledge for safe execution.

Summary:

• Anterior approaches, including Pfannenstiel and modified Stoppa, are effective for pubic symphysis ruptures and iliac wing fractures.
• Anterolateral approaches provide access to the sacroiliac joint for luxations and complex fractures.
• Combined anterior approaches allow simultaneous stabilization of ventral and dorsal instabilities with minimal soft tissue trauma.

Impact:

• Anterior approaches remain a cornerstone in managing pelvic ring instabilities, particularly in challenging clinical scenarios.
• Provides a comprehensive overview of surgical techniques for orthopedic trauma surgeons.
• Highlights the continued importance of open reduction and internal fixation in specific patient populations.