Anterior pelvic external fixation: is there an optimal placement for the supra-acetabular pin?

Anterior pelvic external fixation using supra-acetabular bone pins is frequently used for manipulation and reduction of unstable pelvic ring injuries prior to definitive fixation. The supra-acetabular bone pin must be strategically placed in order to provide optimal frame stability, patient comfort, and hip mobility, without obstructing subsequent osseous fixation pathways. We describe a technique for alternative placement of supra-acetabular bone pins. The intraoperative imaging is detailed. The bone pin starting point is located more cranially at the anterior inferior iliac spine than previously described and the pin is directed to accommodate better hip motion.