pelvic fractures

Acute management

EMST / ATLS PrinciplesPelvic Fracture APC


Usually polytrauma

- 10% mortality



1. Volume replacement

2. Reduce pelvic ring

3. Stop exsanguination

- external stabilisation / surgery / embolisation


Associated Local Injuries


Arterial bleeders




Unusual anatomic convergence of ilium, pubis and ischium

- covered entirely by hyaline cartilage

- except at acetabular fossa, which is the site of attachment of the ligamentum teres

- deepened by peripheral fibrocartilage labrum


2 column theory (Letournel and Judet)


Anterior Column 

- superior pubic ramus

- anterior acetabular wall, anterior dome

AP Compression

APC compression




Non Operative

- < 2.5 cm displacement

- indicates SS and ST intact

- nil posterior opening




1.  > 2.5 cm

- single anterior plate through Pfannelstiel incision


2.  Posterior SIJ disruption

- reduction and posterior stabilisation

- usually with SI screws



Pelvis Anatomy


Pelvis is a true ring

- any anterior fracture must have a posterior injury as well

- integrity of the posterior sacroiliac complex is key


Bony Anatomy


2 innominate bones + sacrum

Symphysis pubis < 5mm

SI joint 2-4 mm