The unstable pelvic fracture. Operative treatment.

While the pendulum has swung to the operative side, open reduction and internal fixation will surely not prove to be the panacea for all unstable pelvic fractures. The lasting effects, however, of attempts at aggressive fixation of the pelvic fracture will be the principles of management that are being established. This begins with the recognition of pelvic instability. It is in these unstable injuries that obtaining and maintaining an anatomic reduction is the best way to alter the natural history of the untreated pelvic fracture and to maximize the probability of obtaining a good long-term result. While the actual methods of internal and external fixation will continue to change, this principle is unlikely to alter. Therefore, if effective treatment can be achieved by closed means alone, that is an acceptable method. Similarly, external, internal, and combined operative and traction treatment methods that achieve this goal would also be acceptable. The question remains: Which method achieves the goal of obtaining and maintaining an anatomic reduction yet minimizes the early and late morbidity? This question is best answered by appropriate preoperative evaluation, subsequent planning, and precise, technically skillful surgery done by an experienced surgeon.