13-Year experience in external fixation of the pelvis: complications, reduction and removal

Eur J Trauma Emerg Surg. 2016 Feb;42(1):91-6. doi: 10.1007/s00068-015-0499-7. Epub 2015 Feb 24.


Purpose: To evaluate the complications associated with anterior pelvic external fixation and the success of this device in maintaining reduction when used in conjunction with sacroiliac screws.

Methods: Through a retrospective clinical study at an academic Level I Trauma Center, 129 patients fit the criteria for inclusion with a mean duration of anterior pelvic external fixation of 62 days and mean follow-up of 360 days. Charts were reviewed for complications postoperatively. The symphysis diastasis, vertical displacement and posterior displacement of each hemipelvis were quantified from pelvic radiographs.

Results: Of the 129 patients receiving anterior pelvic external fixation, 14 (10.9 %) presented to an emergency department for problems with their anterior pelvic external fixation. Of these 14 patients, 7 (5.4 %) required readmission, all for infectious concerns necessitating IV antibiotics. 6 (4.7 %) required formal operative debridement and device removal. 13 patients (10.1 %) had superficial pin site infections successfully treated with oral antibiotics. Reduction was maintained (rated as fair, good or excellent) in all patients with radiographic follow-up (n = 74, average radiographic follow-up of 216 days) following removal of their anterior pelvic external fixation. 38 patients (30.4 %) had their anterior pelvic external fixation removed in clinic, while 87 (69.6 %) had formal removal in the operating room.

Conclusion: While previous data suggest high complication rates in definitive anterior pelvic external fixation, we present the largest cohort of patients receiving anterior pelvic external fixation and sacroiliac screws, demonstrating a low complication rate while maintaining reduction of the pelvic ring. In addition, we found that these devices could be reliably removed in a clinic setting.

Keywords: Anterior pelvic external fixation (APEF); External fixation; Pelvis; Sacroiliac screws.

Publication types

  • Clinical Study

MeSH terms

  • Adult
  • Bone Screws
  • External Fixators
  • Female
  • Fracture Fixation / methods*
  • Fractures, Bone / surgery*
  • Humans
  • Ilium / injuries
  • Ilium / surgery
  • Male
  • Middle Aged
  • Pelvic Bones / injuries*
  • Pelvic Bones / surgery
  • Retrospective Studies
  • Sacrum / surgery
  • Treatment Outcome
  • Young Adult