External Fixation of the Pelvis (Iliac Crest Technique)

1. Clinical Indications

a. Unstable pelvis fracture not amenable temporizing stabilization with pelvic sheet or binder

b. Temporizing stability of proximal femur fractures that require pelvic pins given their location

c. Significant perineal or rectal wounds that preclude use of a binder

2. Damage control surgery without fluoroscopy. If fluoroscopy is available, and the surgical team is appropriately trained and comfortable with this technique, supra-acetabular pins should be placed under radiographic guidance.

3. Key Anatomy

a. Anatomic landmark for safe pin placement using the Iliac Crest Technique is two fingerbreadths posterior to the anterior superior iliac spine (ASIS) which is palpable in nearly everyone.

4. Steps

a. Mark an incision approximately two fingerbreadths posterior to the ASIS along the iliac crest.

b. Sharply dissect down to expose the iliac crest. You may dissect soft tissues off to expose inner and outer tables of the iliac crest.