Extra-articular Unstable Iliac Fractures: Associated Injuries, Fixation Strategies, and Outcomes

Abstract

Objective: To characterize the associated injuries, fixation constructs, and outcomes of extra-articular unstable iliac fractures.

Design: Retrospective cohort study.

Setting: Level I trauma center.

Patients: Thirty-three extra-articular unstable iliac fractures treated over a 20-year period.

Intervention: Percutaneous or open fixation of iliac fractures at the pelvic brim AND/OR iliac crest.

Main outcome measures: Incidence of union, fixation failure, and angiography at the time of injury.

Results: Twenty-five patients were treated operatively with appropriate follow-up. Four patients had fixation failure with displacement, all in the group with only brim OR crest fixation (4/8 patients, 50% rate). In patients with both crest AND brim fixation (n = 17), there were no cases of implant failure or late displacement. In displaced fractures (n = 22), 4 patients (18%) required embolization by interventional radiology. In all 4 cases, the superior gluteal artery was embolized. In patients with both crest AND brim fixation, all went on to uneventful union with an average Visual Analog Scale (VAS) pain score of 0.9 (range, 0-5) at final follow-up.

Conclusions: Extra-articular unstable iliac fractures are high-energy injuries that demonstrate a high rate of union when both pelvic brim AND iliac crest fixation is used. Approximately 1 in 5 patients with a displaced iliac fracture presented with a superior gluteal artery disruption requiring embolization. Pelvic brim OR iliac crest fixation used in isolation was associated with a fixation failure rate of 50%, supporting previous biomechanical work.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.