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Supra-acetabular Pin Placement Without Fluoroscopy During Anterior Pelvic External Fixator Application

March 01, 2020

Contributors: Michael Divella, DO; Christopher Hoehmann, DO; Nathaniel Osborn, DO; David Galos, MD, FAAOS

Keywords: external fixation

High-energy pelvic ring injuries are associated with a substantial rate of mortality and may require emergent stabilization. In critically ill patients, an effective method for provisional stabilization involves the placement of an anterior pelvic external fixator. During anterior pelvic external fixator application, only one option is available for iliac crest pin placement; however, recent literature suggests supra-acetabular pin placement is a biomechanically superior and more ideal pin location. Traditional methods for supra-acetabular pin placement require a sterile environment in an operating room, with complicated and time-consuming imaging techniques that involve fluoroscopic or ultrasonographic guidance. However, because of the high-energy nature of pelvic ring injuries, patient physiology may prevent a safe trip to the operating room and preclude the use of tedious image-guided techniques. This video describes a technique that can be performed at the bedside without imaging guidance.