From the Guidelines
Iliac crest fractures should be managed with a focus on pain control, rest, and gradual mobilization, as most cases heal without surgery in 6-8 weeks, and surgical intervention is typically reserved for severely displaced or unstable fractures 1.
Initial Management
The primary goal in managing iliac crest fractures is to control pain and promote healing. This can be achieved through the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-600mg every 6 hours) or naproxen (500mg twice daily) for 1-2 weeks, combined with acetaminophen (1000mg every 6 hours) as needed.
Role of Pelvic Binders
In cases of hemodynamically unstable pelvic fractures, including those involving the iliac crest, the application of a pelvic binder can be an effective tool to reduce pelvic volume and control hemorrhage 1. Commercial pelvic binders are more effective than homemade ones, but the latter can be used in low-resource settings. It's crucial to remove the binder within 24-48 hours to avoid complications such as skin necrosis and pressure ulcerations.
Rehabilitation and Follow-Up
Rest is essential initially, followed by a gradual increase in activity as tolerated. Physical therapy should commence after the acute pain subsides, usually within 2-3 weeks, focusing on gentle strengthening exercises and range of motion. Patients should use crutches or a cane for the first few weeks to reduce weight-bearing on the affected side. Follow-up imaging at 4-6 weeks is recommended to assess healing progress.
Considerations for Specific Patient Groups
In elderly patients, even minor trauma can cause significant pelvic fractures or bleeding due to bone fragility and decreased regulatory system function. Angiography may have a more significant hemostatic effect than pelvic binding in these cases 1. For pregnant women, the pelvis can be stabilized with internal rotation of the legs and pelvic binder positioning.
Key Points for Management
- Pain management with NSAIDs and acetaminophen
- Rest followed by gradual mobilization
- Use of pelvic binders in hemodynamically unstable cases
- Removal of pelvic binders within 24-48 hours
- Physical therapy after acute pain subsides
- Follow-up imaging at 4-6 weeks
- Consideration of specific patient factors such as age and pregnancy status 1.
From the Research
Causes and Complications of Iliac Crest Fractures
- Iliac crest fractures can occur due to various causes, including road traffic accidents (RTAs) 2 and bone graft harvesting from the iliac crest 3.
- Fractures due to posterior iliac crest harvesting can lead to significant disability and often require complex surgical treatments 3.
- Anterior iliac crest fractures, on the other hand, tend to heal spontaneously without further complications, although they can be painful 3.
Treatment and Management of Iliac Crest Fractures
- Conservative procedures, such as immobilization, medical treatment, and physical therapy, can be effective in managing iliac crest fractures 2.
- External fixation, including iliac crest and supraacetabular external fixators, can be used to stabilize pelvic ring injuries 4.
- Fixation constructs, such as percutaneous or open fixation of iliac fractures at the pelvic brim and/or iliac crest, can be used to treat extra-articular unstable iliac fractures 5.
- Pain management is crucial in the treatment of iliac crest fractures, and techniques such as fascia iliaca compartment block (FICB) can be effective in reducing postoperative pain 6.
Outcomes and Prognosis of Iliac Crest Fractures
- Extra-articular unstable iliac fractures can demonstrate a high rate of union when both pelvic brim and iliac crest fixation is used 5.
- Approximately 1 in 5 patients with a displaced iliac fracture may require embolization due to superior gluteal artery disruption 5.
- The use of FICB can improve postoperative pain on movement compared to intravenous acetaminophen without increasing the complication rate 6.