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