External fixation of the pelvis is indicated for temporary or definitive stabilization of unstable pelvic ring injuries.
Although the techniques can be performed without x-ray guidance, the use of x-ray guidance is recommended, especially when using supra acetabular pins.
Following temporary stabilization, after the patient is resuscitated, the external fixation may be converted to internal fixation. This is preferred as prolonged external fixation may lead to patient discomfort, skin problems, and local infections.
It is important to remember that external fixation (whether supra acetabular or iliac crest) predominantly controls and stabilizes the anterior pelvic ring. In most cases supplemental stabilization or fixation is required for associated posterior pelvic ring injuries.
Placement of the iliac crest external fixator is problematic in obese patients.
This procedure is not fracture-specific and therefore illustrated using an intact pelvic ring. When there is pelvic disruption the orientation of the two innominate bones to each other is disturbed. The pins must be placed on each side wherever the bone lies. This may appear odd until the disruption is corrected.