Indications and techniques of external fixation of the injured pelvis

High energy pelvic ring disruption represents a serious clinical problem with an overall reported mortality rate of approximately 10% (1). However, the mortality for open pelvic fractures approaches 50% (2). This alarmingly high rate has two major components. The first is death due to uncontrollable haemorrhage, often associated with terminal diffuse intravascular coagulation. The second is linked with the serious associated injuries. Improved resuscitation techniques have a direct bearing on both these components and should reduce morbidity and mortality (3,4). The external fixator has a major role to play during resuscitation and, in particular, in the control of bleeding. However, this primary function must not be confused with the more limited secondary role for the external fixator as a definitive form of treatment for certain pelvic fractures. This paper gives clear guidelines on the indications for the use of the external skeletal fixator with pelvic fractures and goes on to discuss pin placement and frame configuration in relation to the biomechanics and biology of the injury.