Intraoperative assisted O-arm navigation imaging for unstable pelvic fractures in INFIX / 中国骨伤

OBJECTIVE@#To investigate the effect of internal external fixator assisted O-arm navigation imaging in the treatment of unstable pelvic fractures.@*METHODS@#From May 2019 to November 2019, 15 patients with unstable pelvic fractures were treated by intraoperative O-arm navigation imaging using INFIX technology. There were 6 males and 9 females. The age ranged from 24 to 66 years old. The course of disease ranged from 2 to 14 days. According to Tile classification, there were 1 case of B1 type, 8 cases of B2 type, 3 cases of C1 type, and 3 cases of C2 type. According to Young-Burgess classification, there were 8 cases of LC, 1 case of APC, 4 cases of VS, 2 cases of CM. Preoperative routine pelvic anteroposterior film, entrance position, exit position and pelvic CT three-dimensional reconstruction were performed. Intraoperative O-arm navigation system three-dimensional reconstruction and triplane scanning imaging were used to evaluate the effect of intraoperative reduction. The anterior pelvic ring was fixed with internal external fixator, and the posterior ring was fixed with sacroiliac screw, plate screw or lumbar iliac screw. The operation time, intraoperative bleeding and nail placement were observed and recorded. The quality of fracture reduction was evaluated by Matta standard, and the postoperative function was evaluated by Majeed function score.@*RESULTS@#Wound healing was good in all patients without vascular, nerve and local irritation complications. All the 15 patients were followed up for 10 to 16 months. The fracture reduction was evaluated according to the Matta scoring standard, 9 cases were excellent results, 5 cases were good, and 1 case was medium. The Majeed functional score was 0 to 95 points.@*CONCLUSION@#The built-in external fixator assisted O-arm navigation imaging system in the treatment of unstable pelvic fractures. The reduction effect is evaluated in advance, the operation time is shortened, and the accuracy of internal fixation is improved. The operation is simple, safe and less bleeding. The operation is in line with the principles of minimally invasive medical treatment and precision medical treatment in orthopedics, which is conducive to the recovery of patients' postoperative function and rapid recovery.

Anterior subcutaneous internal fixation combined with posterior percutaneous iliosacral screw for treatment of unstable pelvic fractures / 中国修复重建外科杂志

Objective: To assess the effectiveness of anterior subcutaneous internal fixation (INFIX) combined with posterior percutaneous iliosacral screw for the treatment of unstable pelvic fractures. Methods: Between August 2016 and November 2017, 19 cases of unstable pelvic fractures were treated with anterior subcutaneous INFIX combined with posterior percutaneous iliosacral screw. There were 14 males and 5 females, with an average age of 40.6 years (range, 17-69 years). Causes of injury included traffic accident injury in 11 cases, falling from height in 5 cases, bruise injury by heavy object in 3 cases. According to Tile classification, there were 2 cases of type B1, 6 cases of type B2, and 11 cases of type C. Anterior ring injuries included bilateral pubic ischial ramus fractures in 12 cases, unilateral pubic ischial ramus fractures in 5 cases, and symphysis pubis separation in 2 cases. Posterior ring injuries included sacroiliac ligament injuries in 2 cases, unilateral iliac bone fractures in 3 cases, unilateral sacral fractures in 11 cases, unilateral sacroiliac joint dislocation in 2 cases, and bilateral sacral fracture in 1 case. The intraoperative blood loss and operation time were recorded, and the fracture healing and postoperative complications were observed. Matta score was used to evaluate the reduction of fracture, and Majeed score was used to evaluate the postoperative function of patients. Results: The operation time was 47-123 minutes (mean, 61.4 minutes) and the intraoperative blood loss was 50-115 mL (mean, 61.1 mL). One case had superficial infection at the site of screw implantation, and 1 case had unilateral cutaneous nerve stimulation, which were cured after corresponding treatment. There was no damage of urinary system, reproductive system, and intestine. All cases were followed up 12-25 months (mean, 18.1 months). All the fractures healed after operation, the average healing time was 9.5 weeks (range, 8-13 weeks); no nonunion, delayed healing, internal fixation loosening, fracture, and other situations occurred. Of the 2 patients with lumbosacral plexus injury before operation, 1 recovered completely and 1 had residual mild claudication. At last follow-up, the reduction of fracture was evaluated by Matta scoring standard, the results were excellent in 13 cases and good in 6 cases, with an excellent and good rate of 100%; the function was evaluated by Majeed scoring standard, the results were excellent in 15 cases and good in 4 cases, with an excellent and good rate of 100%. Conclusion: Minimally invasive pelvic stabilization by using anterior subcutaneous INFIX and posterior percutaneous iliosacral screw for treatment of unstable pelvic fractures, can achieve good fracture reduction and definitive stabilization with minimum complications and obtain excellent functional outcomes.

Fixation Options of Unstable Posterior Pelvic Ring Disruption: Ilio-Sacral Screw Fixation, S2AI Fixation, Posterior Tension Band Plate Fixation, and Spino-Pelvic Fixation

The fixation methods that can be used for unstable posterior pelvic ring injuries have undergone many innovative changes due to the recent development of surgical and imaging techniques. After understanding the appropriate indications of first and second sacroiliac screw fixation and spinopelvic fixation, innovative methods, including the trans-sacral screw fixation, posterior tension-band plate fixation, and the S2AI screw, would be chosen and applied. Considering the anatomical complexity and proximity to the surrounding vessels and nerves in the posterior fixation, the safe zone according to the fixation options should be well understood in preoperative planning. Moreover, the functional reduction of the posterior pelvic ring through the reduction and fixation of the anterior lesion should be achieved before placing the implant to reduce the number of malposition-related complications.

Bilateral Gluteal Necrosis and Deep Infection after Transarterial Embolization for Pelvic Ring Injury in Patient with Hemodynamic Instability: A Case Report

Transarterial embolization is accepted as effective and safe for the acute management in hemodynamically unstable patients with pelvic ring injury. However, transarterial embolization has potential complications, such as gluteal muscle/skin necrosis, deep infection, surgical wound breakdown, and internal organ infarction, which are caused by blocked blood flow to surrounding tissues and organs, and many studies on the complications have been reported. Here, we report an experience of the management of gluteal necrosis and infection that occurred after transarterial embolization, with a review of the relevant literature.

Surgical Outcome of Posterior Pelvic Fixation Using S1, S2 Screws in Vertically Unstable Pelvic Ring Injury

PURPOSE: Iliosacral screw fixation is an effective and less invasive method that is used widely for the definitive treatment of unstable pelvic ring injuries. On the other hand, fixation failures after iliosacral screw fixation have been reported in vertically unstable pelvic ring injuries. This study examined the surgical outcomes of posterior pelvic fixation using S1 and S2 screws in vertically unstable pelvic ring injuries. MATERIALS AND METHODS: Between January 2011 and April 2016, 17 patients with vertically unstable pelvic ring injuries who met the minimum 1 year follow-up criteria were treated with internal fixation using posterior pelvic S1 and S2 screws. Their mean age was 43.9 years. According to the AO/OTA classification, 10 patients had C1, 6 had C2, and 1 had C3 injuries. Surgical treatments of single or multiple steps, where necessary, were performed by two surgeons. The clinical and radiologic outcomes were assessed retrospectively using radiographs and medical records. RESULTS: Overall, 16 patients had bone healing without screw loosening; however, one patient could not maintain anterior pelvic fixation because of an open fracture and deep infection in the anterior pelvic ring. Of five patients who complained of neurological symptoms after injury, three had partially recovered from their neurological deficit. At the last follow-up, the clinical outcomes according to the Majeed score were excellent in 5, good in 6, fair in 4, and poor in 2 patients. The postoperative radiologic outcomes by Matta and Tornetta's method were excellent in 5, good in 8, and fair in 4 patients. Malposition of the S2 screw was identified in one case. The mean time to union was 14.6 weeks after surgery. CONCLUSION: S1 and S2 screw fixation can be an effective treatment option for posterior pelvic stabilization in vertically unstable pelvic ring injuries when considering the surgical outcomes, such as screw loosening and loss of reduction.

Outcome of Surgical Treatment of AO Type C Pelvic Ring Injury / 대한고관절학회지

PURPOSE: To evaluate the radiologic and clinical outcomes of AO type C pelvic ring injury and identify the prognostic factors. MATERIALS AND METHODS: We studied 53 patients who were treated for AO type C pelvic ring injury from January 2002 to February 2010. Mean age and mean follow-up duration were 42.4 years and 14 months, respectively. We had 8 cases of AO type C1-1, 19 cases of C1-2, 11 cases of C1-3, 6 cases of C2 and 9 cases of C3 injury. We analyzed type of fracture, displacement, method of fixation and associated injuries. Radiologic outcome was evaluated with Matta and Saucedo criteria and clinical outcome was evaluated using Majeed score. RESULTS: The average Majeed score was 86.2 distributing as 36 excellent cases, 15 good cases and 2 fair cases. Using radiologic Matta and Saucedo criteria, patients were divided as 31 excellent cases, 17 good cases and 5 fair cases. There was no significant difference between the outcomes of anterior, posterior and antero-posterior fixation. Neurologic injury was the reason for an unsatisfactory functional outcome. We identified two cases with complication, one with postoperative infection and the other with nonunion following anterior-posterior fixation. CONCLUSION: Satisfactory radiologic and clinical outcomes were obtained with open reduction and internal fixation in the management of AO type C pelvic ring injuries. Neurologic injuries affected the clinical outcome.

Dyspareunia Caused by Pelvis Malunion / 대한고관절학회지

In unstable pelvic ring injury, if there is damage to both the anterior and posterior, both anterior and posterior fixation will be needed in order to stabilze the pelvic ring. A female patient complained of dyspareunia due to malunion and additional bone bridge at the inferior ramus of the pelvis. She should have undergone both anterior and posterior fixation, but had undergone anterior fixation only. We report on a patient who was treated successfully with resection of additional bone bridge, scar tissue and adhesive band around the vagina.

Neurologic Injury within Pelvic Ring Injuries

PURPOSE: To evaluate the incidence of neurologic injury in pelvic ring injuries and to assess the risk factors for neurologic injury related to pelvic fractures. MATERIALS AND METHODS: Sixty-two patients with the pelvic ring injury were enrolled in the study from March 2010 to May 2013. When the neurologic injury was suspected clinically, the electro-diagnostic tests were performed. Combined injuries, fracture types, and longitudinal displacements were examined for correlations with the neurologic injury. RESULTS: There were 7 cases of AO/OTA type A, 37 cases of type B, and 18 cases of type C. Among them, 25 patients (40%) had combined spine fractures, and the average of longitudinal displacement was 7 mm (1-50 mm). Of the 62 patients, 13 (21%) had neurologic injury related with pelvic fractures; 5 with lumbosacral plexus injury, 5 with L5 or S1 nerve injury, 2 with obturator nerve injury, and 1 case of lateral femoral cutaneous nerve injury. There were no relationships between the neurologic injuries and fracture types (p=0.192), but the longitudinal displacements of posterior ring and combined spine fractures were related to the neurologic injury within pelvic ring injury (p=0.006, p=0.048). CONCLUSION: The incidence of neurologic injury in pelvis fracture was 21%. In this study, the longitudinal displacements of posterior ring and combined spine fractures were risk factors for neurological injury in pelvic ring injury.

Anatomical Study of Symphysis Pubis Using 3 Dimensional Computed Tomography in Koreans

PURPOSE: To acquire anatomical data for the normal pelvic bone structure using three-dimensional computed tomography (3D CT) and to propose the most appropriate angle and screw length for safe screw insertion during symphysis pubis plating. MATERIALS AND METHODS: We performed 3D CT analysis in 52 patients who required plating and selected a medial and lateral insertion point between the symphysis pubis and the pubic tubercle. Using a three-dimensional medical image analysis program, we evaluated the appropriate screw length, sagittal angle, and oblique angle at each point in this cohort. RESULTS: At the medial point, the sagittal angle was determined to be 49.1degrees with an average screw length of 49.4 mm. At the lateral point, we calculated an average screw length of 49.1 mm, oblique angle of 23.2degrees, and sagittal angle of 45.7degrees. The screw length was longer in men than in women (4.6 mm and 7.3 mm, respectively) at the medial and lateral point. CONCLUSION: At the symphysis pubis diastasis, we can insert the screw caudally at 49degrees with a minimal length of 37 mm at the medial point. We can insert the screw caudally at 46degrees, medially at 23degrees, with a minimal 34 mm length at the lateral point.

Pediculo-Iliac Screw Fixation in Vertically Unstable Posterior Pelvic Ring Injury / 대한정형외과학회잡지

Herein, we report 5 cases of vertically unstable posterior pelvic ring injuries treated by pediculoiliac fixation. We enrolled 5 patients (male 3, female 2) with vertically unstable posterior pelvic ring injuries treated by pediculo-iliac fixation. Prior to and following the surgery, radiologic results were compared using Matta and Saucedo's method and the clinical results before and after surgery were compared using the Postel score. The outcomes of radiological evaluation were anatomic reduction in 3 cases and nearly anatomic in 1. The mean postel score at last follow up was very good in 4 cases and poor in 1 case. Lumbosacral pediculo-iliac screw fixation enables early ambulation and it is considered a useful method.

Surgical Fixation of Sacroiliac Joint Complex in Unstable Pelvic Ring Injuries / 대한고관절학회지

PURPOSE: To evaluate the effectiveness and clinical outcomes of surgical fixation of a sacroiliac joint complex in unstable pelvic ring injuries. MATERIALS AND METHODS: We selected sixteen cases in our hospital from 2006 to 2010 that underwent surgical fixation of the sacroiliac joint complex and had unstable pelvis ring injuries corresponding to B and C of Tile classification. Plate fixation through an intra-pelvic anterior approach was performed for 9 cases, tension band plate fixation for 2 cases, iliosacral screw fixation for 4 cases, and spino-pelvic fixation through extra-pelvic posterior approach for 1 case. Radiological and clinical evaluations were implemented to determine the results of treatment. RESULTS: Bone union was observed in all patients. For radiological evaluation using the Matta and Saucedo criteria, 15 cases were above the nearly-anatomic reduction. Out of 10 cases that performed rotational displacement analysis, 9 cases were above fair. All cases had above moderate clinical results as well. CONCLUSION: For unstable pelvic ring injuries, the satisfactory radiological and clinical results have been obtained through the anatomical reduction of the sacroiliac joint complex and firm internal fixation. And from the evaluation of fracture types, the Type C fracture and vertical shear type fractures showed relatively poor results.

Surgical Fixation of Sacroiliac Joint Complex in Unstable Pelvic Ring Injuries / 대한고관절학회지

PURPOSE: To evaluate the effectiveness and clinical outcomes of surgical fixation of a sacroiliac joint complex in unstable pelvic ring injuries. MATERIALS AND METHODS: We selected sixteen cases in our hospital from 2006 to 2010 that underwent surgical fixation of the sacroiliac joint complex and had unstable pelvis ring injuries corresponding to B and C of Tile classification. Plate fixation through an intra-pelvic anterior approach was performed for 9 cases, tension band plate fixation for 2 cases, iliosacral screw fixation for 4 cases, and spino-pelvic fixation through extra-pelvic posterior approach for 1 case. Radiological and clinical evaluations were implemented to determine the results of treatment. RESULTS: Bone union was observed in all patients. For radiological evaluation using the Matta and Saucedo criteria, 15 cases were above the nearly-anatomic reduction. Out of 10 cases that performed rotational displacement analysis, 9 cases were above fair. All cases had above moderate clinical results as well. CONCLUSION: For unstable pelvic ring injuries, the satisfactory radiological and clinical results have been obtained through the anatomical reduction of the sacroiliac joint complex and firm internal fixation. And from the evaluation of fracture types, the Type C fracture and vertical shear type fractures showed relatively poor results.

Operative Treatment of Unstable Pelvic Ring Injury

PURPOSE: To analyze the clinical and radiological results of the different fixation methods according to the type and displacement of unstable pelvic ring injuries. MATERIALS AND METHODS: Twenty-three patients with unstable pelvic ring injuries from January 2005 to December 2009 were classified according to the AO/OTA classification system. When patients had been diagnosed with unstable pelvic ring injuries with partial instability, they were treated by anterior fixation with a plate and posterior percutaneous iliosacral screw fixation. When patients had been diagnosed with unstable pelvic ring injuries with complete instability, they were treated by open reduction and anterior to posterior fixation with a plate through the ilioinguinal approach. The radiological results were evaluated using Matta and Saucedo's method, and the clinical results were evaluated using Rommens and Hessmann's method. RESULTS: The outcomes from the radiological evaluation were that the displacement of the posterior pelvic ring were improved by about 6.65 mm in unstable pelvic ring injuries with partial instability. The displacement of the posterior pelvic ring were improved by about 7.8 mm in unstable pelvic ring injuries with complete instability. The clinical results were excellent in 13 cases and good in 6 cases on latest follow-up. CONCLUSION: Good results can be achieved by selecting the treatment method according to the type of unstable pelvic ring injurie and displacement.

Pelvic Ring Injury

The function of the pelvic bone is to transmit the body weight to the lower extremities and protect the internal organs in the abdomen and pelvic cavity. Most pelvic fractures occur from high energy trauma, and injuries associated with other parts of the body are common. The characteristics of pelvic fractures may have a significant effect on the patient's general condition and prognosis after treatment. Therefore, the patient's general condition should be considered before treating pelvic fractures to decrease the complications and mortality. After the patient's vital signs are stabilized, simple X-rays and CT should be examined to evaluate the fracture pattern and possible injury mechanism. A high energy induced pelvic ring injury should be treated by experienced surgeons and the biomechanics should be understood completely beforehand to achieve the best possible result.

Late Reconstruction and Rehabilitation 10-months after Injury in a Patient with unstable Pelvic Ring Fracture / The Japanese Journal of Rehabilitation Medicine

We report a patient who received pelvic reconstruction for unstable pelvic ring fracture with severe open-book deformity after 10 months of conservative therapy and regained the ability to walk. The present report indicates that patients with unstable pelvic ring fractures should undergo reduction and fixation in the early period. Unstable pelvic ring fracture is a result of high energy trauma. It is difficult to find the best time for intervention once it has been delayed. This AO Type C3 unstable pelvic ring fracture was examined by CT imaging for pelvic deformity. Independence in activities of daily living (ADL) was evaluated using the Functional Independence Measure (FIM). After pelvic ring deformity was reduced by an external fixation-traction system, anterior fixation was performed and contracture of short external rotators was released. The patient's hip function normalized after the procedures and he was able to walk again 6 months later. Concomitant nerve paralysis also recovered after the reduction and fixation of the pelvic deformity. Unstable pelvic ring fractures may progress to pelvic deformity and adversely affect the patient's ADL unless they are managed with reduction and fixation in the early period. Unstable pelvic ring injury should primarily be treated with reduction and fixation in the acute phase.

Anterior Plating and Ilio-sacral Screwing for Unstable Pelvic Injury / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of iliosacral screw fixation with anterior plating in the management of an unstable pelvic ring injury. MATERIALS AND METHODS: Nineteen patients with an unstable pelvic ring injury were enrolled in this retrospective study. All patients were followed up for at least 1 year. The mean age of the patients was 43 years. According to the AO-OTA classification, there were five B2 injuries, 11 C1 injuries, and 3 C2 injuries. After anterior fixation by plating, ilio-sacral screw fixation was performed percutaneously under the C-arm guide. RESULTS: All cases united except for 1 case of nonunion at the pubic ramus. The radiology results showed 9, 7, 2 and 1 case of anatomic, nearly anatomic, moderate and poor reduction, respectively. Sixteen out of 19 patients had a good or excellent functional result. Two moderate and one poor result were from an unsatisfactory reduction in a type C injury with the residual neurological signs. Screw misplacement with neurological compromise occurred in one patient but there were no adverse sequelae after its removal. Regarding the complications, there were two cases of screw loosening, two cases of anterior metal failures, and 1 case of a deep infection. CONCLUSION: Percutaneous ilio-sacral screwing with anterior plating may be a useful method for treating unstable pelvic ring injuries, and the reduction quality and neurological signs are important.

Percutaneous Iliosacral Screw Fixation for Pelvic Ring Injury / 대한정형외과학회잡지

PURPOSE: This study evaluated the surgical outcomes of percutaneous iliosacral screw fixation for an unstable pelvic ring injury. MATERIALS AND METHODS: Twenty patients (20 cases) who were classified as having a Tile classification type B or C pelvic ring injury. Anterior fixation was added in 17 cases to maintain the stability of the anterior pelvic structre. The radiological results were compared using Slatis and Karaharju's method and the clinical results before and after surgery were compared using Moon's method between before and after surgery. RESULTS: The outcomes of the radiological evaluation were excellent in 19 cases, good in 1. The outcomes of the clinical evaluation were excellent in 7 cases, good in 12, and poor in 1. There were similar clinical and radiological results regardless of the number of screws. One patient complained of mild discomfort in the screw entry site. Nonunion developed in one case. However, there was no lloss of fixation observed. No neurological or vascular complications were encountered during the procedure. CONCLUSION: Satisfactory outcomes could be obtained without serious complications after percutaneous iliosacral screws in the unstable pelvic ring fractures. One iliosacral screw fixation provided for the stability in a pelvic ring injury in association with anterior fixation.

Clinical Outcome of AO Type C Pelvic Ring Injury / 대한정형외과학회잡지

PURPOSE: To study the clinical results of AO type C pelvic ring injuries and identify the prognostic factors. MATERIALS AND METHODS: 25 patients were treated for C type pelvic ring fractures between January 1995 and August 2002. The injury mechanism, associated injuries, time from injury to surgery, ICU care, Injury Severity Score, fracture site of posterior ring, displacement, surgical method, and complications were analyzed. Radiological and clinical evaluations of the results were conducted using the Majeed's score. Of the 25 patients, 16 were male, 9 were female, with an average age of 41.6 years. All except one patient had associated injuries and 12 patients had neurological complications. There were 17, 7 and 1 case of C1, C2 and C3 type injuries respectively. Twenty three cases underwent surgical treatment. RESULTS: The average Majeed's score was 66.6 points, and 15 patients (60%) had good or excellent results. The complications included 3 cases of non-union and 1 case of SI joint infection were complications. The clinical results were worse in those patients with neurological symptoms. CONCLUSION: Satisfactory results were obtained after surgical treatment of C type pelvic ring injuries. Neurological injuries affected the clinical outcome and appropriate fixation of the anterior ring was needed for stable fixation of C type pelvic ring injuries.

Problems of Anterior External Fixation in Unstable Pelvic Ring Injury

PURPOSE: To determine the problems of anterior external fixators in unstable pelvic ring injuries. MATERIALS AND METHODS: We reviewed 25 patients with an unstable pelvic ring injuries who had been treated with only anterior external fixator over one year follow-up. By Tile's classification, type B 14, type C 11 and the radiological results were evaluated preoperation, postoperation and bone union state. The clinical evaluation was done in termas of the residual pain, discrepency in limb length, rotational deformities, gait disturbance, neurologic deficiency. RESULTS: In 25 patients with an unstable pelvic ring injuries, 18 (72%) patients were reducted and 3 (17%) patients of 25 were reduction failure at last follow up, they were all Tile type C. The residual pain was graded normal 3, mild 11, moderate 10, severe 1 respectively. The cases with discrepency in limb length and gait disturbance were 6 (all type C), 10 (type B 3, type C 7) respectively. The complication were 4 pin site infection, 3 pressure sore and 1 pyogenic hip arthritis. CONCLUSION: Our results indicate that anterior external fixator should be limited to vitally unstable patients in acute resuscitative phase and cases without vertical displacement.

Operative Treatment of Unstable Pelvic Ring Injury / 대한정형외과학회잡지

The goals of orthopaedic management of pelvic ring injuries are to achieve anatomical reduction and secure fixation of fragment and mobilize the patient as early as possible. Previously, pelvic ring injuries have been treated by a wide variety of conservative methods. Their application, however, necessitated a prolonged period of recumbency with associated likelyhood for many complications and did not facilitate accurate reduction and stabilization of most types, resulting in pelvic deformity, non-union and late sacroiliac joint instability. During the past decade, experience with techniques of external and internal fixation of the pelvis has grown and the goals of the methods include provision for sufficient pelvic stability in satisfactory position so that immediate postoperative bed-to-chair transfers can be undertaken and complications due to prolonged recumbency and pelvic deformity can be markedly reduced. We reviewed 47 cases of unstable pelvic ring injuries treated at the depatment of orthopaedic surgery, Dongkang Hospital from January 1984 to December 1987, and the results were as follows ;1. The highest incidence was in the 4th decade and sex ratio between male and female was 1.6:1 2. The most common cause of injury was traffic accident (68.2%) followed by falling down accident (19%) 3. Associated injuries occurred in 28 cases (60%): injuries of the extremities were most common (30%) followed by head injury (13%) and genitourinary tract injury (11%). 4. According to classification of Pennal et al, lateral compression injury was most common (51.1%). Bucholz Group II injury was 57% of all and Group III, 43%. 5. Operative methods, with which 21 cases were treated, were anterior external fixation with AO apparatus or symphyseal plating in Bucholz Group II injuries ; and external fixation, internal fixation (anterior and/or posterior) or both, in Group III injuries. 6. Advantages of operative treatment of unstable pelvic ring disruptions were, by giving stability, early mobilization; easy care of associated injuries, open wounds and nursing; prevention of possible complications of prolonged recumbent position; rapid reduction of pain; and prevention of late complications such as lumbosacral or pelvic pain and gait disturbance.