Pelvic fractures: operative versus nonoperative treatment

These most difficult patients require an expert early general assessment and rapid resuscitation. We have suggested a treatment algorithm that has helped us in managing these patients. The degree of posterior instability in the initial radiographs of the pelvis is of considerable prognostic value. The patient's bone injury should be rapidly assessed by history, physical examination, and radiological examination, and treatment should progress in a logical fashion on the basis of that assessment. We have found the use of the external skeletal fixator to be helpful in some types of pelvic injury. One must remember, however, that the present external fixators that fix the anterior hemipelvis only may produce increased deformity across the posterior structures in cases of posterior instability of the ring. Refinements in technique may eventually solve that problem. Further research into pelvic biomechanics is required to improve our methods of management of these difficult patients.