Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Use of the AIP (modified Rives-Stoppa) approach for the treatment of acetabular fractures permits good to excellent reduction in the majority of cases while giving excellent visualization and access to the quadrilateral plate and posterior column. The AIP approach has a complication rate that is comparable to the ilioinguinal approach. We recommend the use of this technique as a potential alternative (but not replacement) to the classic ilioinguinal approach when anterior exposure of the acetabulum is required.

Patients with prolonged procedures (i.e., >5 hours) exposing more than three vertebral levels that include C2, C3, or C4 with more than 300-mL blood loss should be watched carefully for respiratory insufficiency.

The reported incidence of poor functional outcomes associated with pelvic fracture may be attributable, in part, to inadequate treatment of misdiagnosed injuries and chronic instability and/or malunion. Performing an examination under anesthesia with dynamic stress fluoroscopy as described in this series revealed occult instability in 50% of presumed APC-1 injuries, 39% of APC-2 injuries, and 37% of LC-1 injuries. We propose a modification to the Young-Burgess Classification system to reflect the dynamic component of pelvic ring instability disclosed on EUA as follows: APC-2a for those injuries requiring anterior only fixation, APC-2b for those injuries that may require treatment with anterior and posterior fixation, LC-1a for those injuries that are stable and do not require internal fixation, and LC-1b for those lateral compression injuries that may require treatment with internal fixation. We conclude that pelvic EUA merits further analysis as an important diagnostic tool that may provide additional information regarding instability of the pelvic ring.

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

No abstract

Triangular osteosynthesis fixation is a reliable form of fixation that allows early full weight-bearing at 6 weeks while preventing loss of reduction in comminuted vertical shear transforaminal sacral fractures. For this study group, operative reduction was maintained until healing in 95% of patients. However, the 1-year follow-up shows a substantial rate of potential technical problems and complications. Of primary concern were the asymmetric L5 tilting with L5-S1 facet joint distraction and the need for a second surgery in all patients to remove painful fixation. Iatrogenic nerve injury occurred in 5 patients (13%) and is thought to arise secondary to fracture manipulation and reduction. We recommend selective use of this technique for comminuted transforaminal sacral fractures in situations only where reliable iliosacral or trans-sacral screw fixation is not obtainable.