| Introduction |
 Most are unstable fractures- Typically progress from iliac crest to greater sciatic notch
- Iliac wing fractures have high incidence of associated injuries
- open injuries
- bowel entrapment
- soft tissue degloving
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| Anatomy |
- Osteology
- pelvic girdle is comprised of
- sacrum
- 2 innominate (coxal) bones
- each formed from the union of 3 bones: ilium, ischium, and pubis
- ilium
- 2 important anterior prominences
- anterior-superior iliac spine (ASIS)
- origin of sartorius and transverse and internal abdominal muscles
- anterior-inferior iliac spine (AIIS)
- origin of direct head of rectus femoris and iliofemoral ligament (Y ligament of Bigelow)
- posterior prominences
- posterior-superior iliac spine (PSIS)
- located 4-5 cm lateral to the S2 spinous process
- posterior-inferior iliac spine (PIIS)
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| Imaging |
- Plain radiographs
- standard set of AP pelvis, inlet/outlet, and judet views
- helpful for evaluating the iliac wing in addition to pelvic stability and possible acetabular involvement
- CT scan
- carefully assess CT scan for signs of bowel entrapment
- evaluate for presence of gas or air in the soft tissues which can be associated with open injury or bowel disruption
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| Classification |
- No specific classification for iliac wing fractures
- Generally described as specific subtypes of more common classification systems
- Tile Classification
- stable (intact posterior arch)
- A1-1: iliac spine avulsion injury
- A1-2: iliac crest avulsion
- A2-1: iliac wing fractures often from a direct blow
- partially stable (incomplete disruption of posterior arch)
- B2-3: incomplete posterior iliac fracture
- unstable (complete disruption of posterior arch)
- C1-1: unilateral iliac fracture
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| Treatment |
- Nonoperative
- mobilization with an assist device
- indications
- nondisplaced fractures
- isolated iliac wing fractures
- Operative
- open reduction and internal fixation
- indications
- displaced fractures of ilium
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| Operative Techniques |
- Wound Mangement
- evaluate all wounds for
- soft tissue disruption or internal degloving injury
- possible soft tissue or bowel entrapment in the fracture site
- prophylactic antibiotics as appropriate
- serial debridements as necessary
- Open Reduction Internal Fixation
- approach
- posterior approach
- ilioinguinal approach
- Stoppa approach (lateral window)
- recommend early reconstruction
- single pelvic reconstruction plate or lag screw along the iliac crest
- supplemented with a second reconstruction plate or lag screw at the level of the pelvic brim or sciatic buttress
- coordination with trauma team
- injury to bowel may require diversion procedures
- plan surgical intervention with trauma team to minimize recurrent trips to the operating room
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| Complications |
- Malunion with deformity of the iliac wing
- Internal iliac artery injury
- Bowel perforation
- Lumbosacral plexus injury
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