Lumbopelvic Fixation Treatment

Indications for Lumbopelvic Fixation

Lumbopelvic fixation is indicated for unstable pelvic ring injuries with posterior instability, particularly rotationally unstable and vertically unstable fracture patterns, with spinopelvic fixation offering the benefit of immediate weight bearing in patients with vertically unstable sacral fractures 1, 2, 3
Posterior pelvic ring instability requiring anatomic fracture reduction and stable internal fixation 1, 2
Vertically unstable sacral fractures where immediate weight bearing is desired 3

Hemodynamically unstable and coagulopathic patients should be successfully resuscitated before proceeding with definitive pelvic fracture fixation (Grade 1B) 1, 4
Hemodynamically stable patients can safely undergo early definitive pelvic fracture fixation within 24 hours post-injury (Grade 2A) 4
Definitive pelvic fracture fixation should be postponed until after day 4 post-injury in physiologically deranged polytrauma patients (Grade 2A) 4
Initial "damage control" external fixation may be used for hemodynamically unstable patients, with delayed definitive internal fixation once the patient is stabilized 4

Pubic symphysis plating is the modality of choice for anterior fixation of "open book" injuries with a pubic symphysis diastasis (Grade 1A) 1, 2
Selected lateral compression patterns with rotational instability benefit from adjunctive, temporary external fixation in conjunction with posterior pelvic ring fixation (Grade 2A) 1, 2

Elderly patients may require special attention to bone quality and fixation methods 5
Open fractures require thorough debridement and appropriate antibiotic coverage 5