Pelvic External Fixation

Indications

  • Rotationally unstable injuries, APC II and III, for temporary or definitive anterior stability
  • Haemodynamic instability after a binder fails, as part of damage control
  • Open pelvic fractures need debridement and diversion where indicated

Position

  • Supine, binder centred over the greater trochanters until the frame is placed
  • Image intensifier with inlet and outlet views

Operative Steps

  1. Iliac crest pins start 2 to 3 cm posterior to the ASIS to avoid the lateral femoral cutaneous nerve
  2. Aim the pins between the inner and outer tables toward the acetabular dome
  3. Supra-acetabular pins from the AIIS are stronger and need an obturator outlet view
  4. Reduce by internal rotation of the hemipelves
  5. Connect bars, leaving room for the abdomen to expand
  6. An anterior frame does not control posterior instability. Use a C clamp or posterior fixation
  7. Two pins per side in the iliac crest or one supra-acetabular pin per side
  8. Ensure the frame does not block a laparotomy

Postoperative Care

  • Pin care, sit up as tolerated
  • Plan definitive fixation once physiology allows
  • Check frame tightness daily
  • Mobilise when pelvis and other injuries allow

Complications

  • Pin infection
  • Lateral femoral cutaneous nerve injury
  • Loss of reduction
  • Pin penetration into the hip joint
  • Pin tract infection
  • Loss of reduction
  • Lateral femoral cutaneous nerve injury

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.