INDICATIONS FOR ANTERIOR FIXATION OF PELVIC FRACTURES

From April 1982 to August 1995, the author treated 127 patients with p elvic ring injuries by open reduction and internal fixation within 3 w eeks of injury, Fifty-five (43%) patients (none of whom had a symphysi s dislocation) had posterior internal fixation without anterior pelvic internal or external fixation, In 37 patients (29%) anterior and post erior internal fixation was performed whereas 35 patients (28%) were t reated by anterior internal fixation alone, Plates and screws were use d for all anterior fixations, Bladder or urethral injury was not consi dered a contraindication to anterior internal fixation, Of 109 patient s who were observed until union of their fractures, 3 required a repea t surgery because of loss of reduction or failure of fixation or both, All 3 patients maintained reduction and healed after the second inter vention, Of 72 anterior internal fixations, 1 deep infection was the o nly surgical complication, A single plate is reliable for fixation of the symphysis pubis and when necessary, the superior pubic ramus, Howe ver, even in displaced and unstable pelvic ring injuries, most fractur es of the pubic rami do not require stabilization by internal or exter nal fixation, Eighty-eight of 105 fractures of the obturator ring were not internally fixed and none required subsequent treatment for nonun ion or loss of reduction; nor did their initial instability cause fail ure of posterior fixation, Internal fixation of the anterior pelvic ri ng, though safe and reliable, should be reserved for symphysis pubis d islocations and only a minority of pubic ramus fractures.