Anterior approaches to the pelvic ring

Anterior approaches for the stabilization of anterior and also posterior B and C type instability of the pelvic ring were the standard procedures before minimally invasive percutaneous methods supported by image intensifiers or navigation devices were established. Anterior approaches are currently still of high relevance for difficult or impossible closed reductions in multiple trauma surgery where the patient must remain in a supine position. They are also used for stabilization of an increasing number of osteoporotic fractures in the elderly which are no longer only treated in specialized pelvic trauma centres. The anterior as well as the posterior part of the pelvic ring can be stabilized via various anterior approaches. A Pfannenstiel incision is appropriate for plating of ruptures of the pubic symphysis and can be extended to a modified Stoppa approach if necessary. Fractures of the iliac wings can be approached either laterally or less traumatically, via an anterolateral approach. The latter equates the lateral window of the ilioinguinal approach to the acetabulum, allows visualization of the entire sacroiliac joint and therefore stabilization of not only iliosacral luxation but also luxated fractures with a small iliac fragment. By a combination of the different approaches it is possible to simultaneously stabilize ventral and dorsal instabilities in type C fractures of the pelvic ring with a minimal amount of iatrogenic soft tissue trauma. Although the described anterior approaches are considered as simple exact knowledge of the endangered structures and general risks for each approach are essential for a safe exposure of the anatomical region addressed.