Background: There are various sites for pin placement in the pelvis. Recent studies have suggested that the supra acetabular pin placement is mechanically stronger and has been recommended as an alternative. The aim of this study is to analyse the morbidity of the most commonly used pin placement sites namely, conventional pin placement into the anterior iliac crest versus the low pin placement into the supra acetabular region.

Methods: Sixty one patients who required pelvic external fixation as part of their management between April 1998 and December 2001 were identified. Three patients died and were excluded from the study. Of the remaining 58 patients, 33 were treated with a supra-acetabular external fixator and 25 had an iliac crest external fixator. The majority of patients sustained the pelvic fracture as a result of road traffic accident. There were no statistically significant differences in the number of patients, mean age, length of stay, ISS or type of fractures for the two patient groups.

Results: Fewer complications were noted in the supra-acetabular group versus the iliac crest group (21.2% vs. 56.0%, p< 0.05). In particular, infection rates were significantly lower in the supra-acetabular group (15.1% vs. 36%, p< 0.05). There were no significant differences between the two groups in the number of pin cut-outs or misplacements, injury to the lateral femoral cutaneous nerve or loss of reduction.

Conclusion: The supra-acetabular technique of pin insertion for pelvic external fixation has fewer complications and should be utilised if an image intensifier is available. The lower rate of pin tract infection is a favourable outcome when secondary pelvic reconstructive procedures are necessary.

Introduction Pelvic ring disruptions have well established biomechanical forces that correlate with fracture pattern. These patterns have considerable soft tissue and ligamentous disruptions associated with high velocity vectors which result in unstable injuries. This study critically evaluates the functional outcome of anatomically and or haemodynamically unstable pelvic ring disruptions treated with operative management and presents a retrospective analysis of injury pattern, surgical therapy and complications in surgically treated Tile B and Tile C disruptions.

Methods This study is a retrospective review of results of the operative management of pelvic fractures at the Alfred Hospital, Melbourne over the period of May 1997 to May 2001 (one to four years) using the Iowa Pelvic Score (Martin-American Academy Meeting 1999) to assess functional outcome. Initial screening resulted in 204 patients with pelvic disruptions via DRG coding. Of this 65 patients were managed operatively and only 34 patients were subquently included in the study. Exclusion criteria were; residual cognitive defect, hip or ace-tabular injury, spinal injury with neurological deficit, repeat trauma or ongoing litigation. The inital data gathered included; age, sex, type of accident, Tile classification, neurological injury, urogential injury, type of treatment, adequacy of treatment, post-operative complications, length of hospital and stay in rehabilitation. A follow-up survey was performed for each of these patients by telephone to obtain a post-operative functional outcome score. Thirty two of the 34 patient were able to complete the survey.

Results Thirty-four patients were included in the study with 29 (85%) males and five (14%) females. The modes of injury were as follows: five motor car occupants, 13 motorbike riders, three pedestrians struck by motorcar, three falls, three occupational and seven other. Twenty-seven were classified as Tile B and seven Tile C. These fractures were treated with the following; external fixation alone was used in four patients, external fixation followed by anterior plating was used for 18 patients, anterior plating and posterior ilio-sacral screws were used for nine patients, three patients received both anterior and posteior plate fixation. The mean number of operations to stabilize the disruptions was two. The major complication incurred by most of the patients was pin site infection. The mean length of hospital stay was 25 days and the mean length of rehabilitation stay was 35 days. Of the 32 patients interviewed all had function outcome scores greater than 70 (good). Most (n=13) of them returned to full time work. All reported cosmetic changes in their pelvis.

Conclusions We feel that this study provided good quality retrospective data for the demographics and surgical therapy used to stabilize pelvic ring disruptions that are unstable. These results were consistent with current belief that internal fixation of pelvic fractures produced good functional outcome.