Iliac bone fractures have unique characteristics. You can
have stable fractures such as avulsion of the iliac spine, anterior superior
spine, due to pull of the Sartorius muscle. There may also be avulsion of the
anterior inferior iliac spine (AIIS) due to the pull of the direct head of the
rectus femoris muscle. The iliac bone can be part of acetabular fractures, and
when it breaks as part of the acetabular fracture, it can be an associated both
column fracture, and the iliac fracture will be seen in the CT scan in a
coronal view. You can also see the “spur sign” which is part of the posterior
ilium in its undisplaced position, and this can be seen in the obturator view.
The fractured ilium can also be a part of pelvic fractures. This can be
partially stable, such as posterior iliac bone fracture in the crescent type.
The fractured pelvis can also be unstable, and you will have unilateral iliac
fracture and complete disruption of the posterior arch complex. If it is not
treated adequately, it can lead to malunion, deformity of the iliac wing and
leg length discrepancy. Isolated iliac fracture occurs due to a direct blow to
the pelvis. It is usually rotationally and vertically stable and is usually
treated conservatively. It is not a benign injury; it can be a serious injury,
especially if the fracture ilium is comminuted. Comminuted iliac fractures are
uncommon and difficult to treat. There can be significant associated injuries
such as soft tissue injury. Iliac and flank soft tissue injuries such as iliac
and flank degloving injuries that is called Morel-Lavallee lesion. In the
internal degloving injury, the fat is sheared off of the fascia. An open
fracture and entrapment of the bowel within the fracture site. There may be a
variety of abdominal, vascular and neurological injuries. If the fracture extends
into the greater sciatic notch, then the patient may have an arterial injury or
a lumbosacral plexus injury. In general, treatment is nonoperative if the
fractured ilium is isolated and nondisplaced. Surgery is done by open reduction
and internal fixation for displaced fractures. In case of open fracture, the
patient may need a colostomy.
