Open reduction and internal fixation of vertical shear pelvic fractures.

The goal in the treatment of vertical shear fractures of the pelvis is to achieve and maintain an accurate reduction of the displaced hemipelvis. Open reduction and internal fixation of the posterior pelvic ring injury along with either internal or external fixation of the anterior pelvic ring injury was used in 12 vertical shear fractures in 11 patients. The posterior fixation was aided by accurate definition of the injury pattern, use of preoperative traction, early surgical treatment, use of flexible instruments, and identification of the posterior sacral foramina, which were used as a guide to allow accurate screw placement into the sacrum and avoid nerve root injury. The procedure was not associated with an increased rate of infection or neural injury. In the ten patients followed more than 1 year there were no late displacements of the hemipelvis and all of the fractures healed.