External fixation in pelvic fractures.

The treatment of unstable pelvic ring fractures, markedly comminuted and displaced acetabular fractures, and combinations of these insults to the pelvis has been an unsolved problem in orthopedics up to the present time. Of the previous methods of treatment, external fixation has appeared to hold the most promise for certain major pelvic insults, especially those accompanied by instability of the pelvic ring. Many of the previously used external fixation devices, however, have not provided adequate stability. Recently we have modified the Hoffmann external frame to provide a simple method of treatment for unstable pelvic ring fractures that permits the patient to undergo immediate mobilization from bed to chair. Certain other complex central acetabular fractures and combined insults involving the pelvic ring, central acetabulum, and proximal femur have been treated by extensive external frames. The results of these methods are described. Although such external devices appear to be superior to previously available methods, nevertheless, in view of their inherent limitations, we have begun to explore possible methods of internal fixation of the posterior portion of the disrupted pelvic ring combined with internal or external fixation of the anterior segment of the pelvis.