A new approach to the internal fixation of unstable pelvic fractures.

Eighteen patients with horizontally or vertically unstable pelvic fractures were operated on with a new intrapelvic technique. There were 11 horizontally unstable and seven vertically unstable pelvic ring fractures. The fractures were exposed through a low Pfannenstiel or lower midline incision combined with an incision at the iliac crest. This is referred to as the ilioanterior approach. At the operation, all lesions in the symphysis, rami, and in the sacroiliac region were reduced and fixed with reconstruction plates and screws. No intraoperative complications ensued. The average intraoperative blood loss was 930 ml and the operation time averaged two and one-half hours. The obtained reduction was maintained in all but one sacral fracture. All fractures united. The functional recovery was uneventful in all the patients. The good results obtained in this relatively small series encourage further development of operative techniques in unstable pelvic fractures.