Pelvic Ring Fixation (Anterior and Posterior)

⚙️What This Procedure Involves

Anterior ring: an incision is made in the lower abdomen (Pfannenstiel or ilioinguinal approach). The pubic symphysis or pubic rami fractures are reduced and fixed with a plate and screws. Alternatively, a retrograde pubic screw can be placed percutaneously. Posterior ring: may be fixed with percutaneous SI screws, posterior plating through an incision over the sacrum, or a combination. Often both anterior and posterior fixation are needed. Total operating time is two to four hours.

💡Why It May Be Recommended

Surgery is required for unstable pelvic ring injuries — fractures that disrupt both the anterior and posterior ring, causing the pelvis to be mechanically unstable. This is common in high-energy trauma.

⚖️Non-Operative Alternatives

Stable pelvic fractures (e.g., isolated pubic rami fractures) are managed with pain relief and mobilisation. Only unstable injuries require fixation.

📋Preparing for Surgery

CT scan with 3D reconstruction for planning. May require emergency stabilisation with an external fixator or pelvic binder first.

✅Expected Benefits

Restoration of pelvic stability allowing weight-bearing and mobilisation. Most patients with successfully treated pelvic ring injuries return to walking.

⚠️Common Risks

• Prolonged recoveryExpected

  Pelvic injuries are major trauma with six to twelve month recovery.

• PainCommon

  Chronic pelvic pain is common after high-energy injuries.

• Blood clotsCommon

  High DVT risk.

🔴Less Common but Serious Risks

• Nerve injuryUncommon

  L5 root, lumbosacral plexus at risk.

• MalunionUncommon

  Asymmetric healing causing leg length discrepancy.

• InfectionUncommon

  Wound or deep infection.

• Sexual/urological dysfunctionUncommon

  From the injury and/or surgery.

• Heterotopic ossificationUncommon

  Unwanted bone formation.

💉Anaesthetic Considerations

General anaesthesia. Significant blood loss potential.

🏃Recovery and Rehabilitation

Weight-bearing restrictions for six to twelve weeks. Physiotherapy essential. Crutches or frame for several months. Return to desk work at six to eight weeks. Full recovery six to twelve months.

📅Follow-Up

Regular X-rays at six weeks, three months, and six months.

❓Frequently Asked Questions