It is clear that immediate pelvic splinting is beneficial, by its ability to reduce bleeding from the unstable pelvis. But, a pelvic binder cannot maintain pelvic alignment until healing is advanced. Until bony stability is obtained with external fixation, a pelvic binder or wrap is advisable to minimize ongoing bleeding.
The long term outcome of significant pelvic ring injuries is often poor. Deformity, failure to heal satisfactorily and related disability are best avoided by anatomic reduction and stable fixation. Additional advantages of stable fixation are relief of pain and early mobilization. When the necessary resources are available, this is achievable for most pelvic ring injuries.
Optimal treatment requires detailed diagnostic imaging, an advanced surgical suite and specialized instruments and implants. When these are not available, the surgeon is still faced with the challenge of obtaining and maintaining the best reduction possible. Instead of accepting deformity, pelvic external fixation with traction is suggested as the most appropriate alternative.
In most resource limited settings, the possibility of placing a pelvic external fixator is, or can be made, available. This may provide adequate control of pelvic alignment during bed rest.
Unfortunately, an external fixator, applied anteriorly, does not control posterior instability in C-type pelvic ring injuries, with complete posterior arch disruption. However, additional skeletal traction can supplement an anterior fixator and improve maintenance of overall pelvic alignment. This is why external fixation should be supplemented for treating unstable pelvic ring injuries.