Plate and Screw Fixation of the Ilium

Abstract

Fractures of the ilium seldom occur in the context of fragility fractures of the pelvis. They may cause partial or complete pelvic ring instability. Fragility fractures of the ilium typically start at the pelvic brim near to the sacroiliac joint and continue cranially and laterally to reach the iliac crest at its most proximal point. In incomplete fractures of the ilium, surgical fracture fixation may be considered as a measure to avoid fracture progression. Complete fractures require internal fracture fixation as spontaneous fracture healing cannot be expected. The anterolateral approach gives surgical access to the iliac fossa as far as the pelvic brim. Fracture reduction is performed under direct view. Fixation at the level of the iliac crest is obtained with one or two screws, which are inserted perpendicular to the fracture plane, between the inner and outer cortex and parallel to the iliac crest. An angular stable plate is placed along the pelvic brim. Proximal screws are inserted parallel to the iliosacral joint, distal screws above the acetabulum in the iliac body. It is recommended to fix fractures of the anterior pelvic ring as well. Early mobilization with weight-bearing is allowed, when tolerated by the patient.