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Fracture of iliac crest — Clinical Guidelines

Overview

Fracture of the iliac crest typically occurs secondary to trauma or during surgical procedures such as bone grafting or internal fixation of pelvic fractures. It often leads to complications like pain, nonunion, and infection.

Diagnosis

Clinical Presentation: Pain, swelling, and tenderness over the iliac crest region 1 6.

Imaging: X-rays are initial diagnostic tools; CT scans provide detailed assessment of bone integrity and associated injuries 1 6.

Grading: Classification systems like the Judet and Letournel classification help assess the extent and displacement of fractures 1.

Management

Conservative Management: Rest, ice, compression, and elevation (RICE protocol) for minor fractures 1.

Surgical Intervention: Open reduction and internal fixation (ORIF) with plates or screws for displaced fractures 1 6.

Bone Grafting: Autogenous or allograft bone grafting may be necessary for nonunion or to promote healing 1.

Infection Management: Antibiotics tailored to culture and sensitivity results if infection is present 1 6.

Special Populations

Elderly: Higher risk of complications; conservative management may be preferred unless displacement necessitates surgery 1.

Comorbidities: Presence of comorbidities like osteoporosis may influence treatment choice and outcomes 1 6.

Key Recommendations

Imaging with CT for Detailed Assessment: Utilize CT scans for comprehensive evaluation of iliac crest fractures to guide treatment decisions (Evidence: Moderate 1 6).

Surgical Fixation for Displaced Fractures: Consider ORIF with internal fixation for displaced fractures to ensure proper alignment and healing (Evidence: Moderate 1).

Antibiotic Therapy for Infections: Initiate targeted antibiotic therapy based on culture and sensitivity results in cases of infected fractures (Evidence: Moderate 1 6).

Bone Grafting for Nonunion: Employ bone grafting techniques for fractures at risk of nonunion to enhance healing (Evidence: Expert opinion 1).

References

1 Koeckerling D, Zielasek C, Stähli P, Wohlfarth B, Rosenov A, Helfenstein F et al.. Patient-specific risk factors for reintervention following primary endovascular treatment of iliac artery disease. Journal of vascular surgery 2024. link 2 Kokkinidis DG, Katsaros I, Jonnalagadda AK, Papanastasiou CA, Katamreddy A, Schizas D et al.. Use, Safety and Effectiveness of Subintimal Angioplasty and Re-Entry Devices for the Treatment of Iliac Artery Chronic Total Occlusions: A Systematic Review of 30 Studies and 1112 Lesions. Cardiovascular revascularization medicine : including molecular interventions 2020. link 3 Henretta JP, Wagner MA, Kirby LB, Douglas MG, MacMillan DJ, Denslow S et al.. Balloon-assisted remote external iliac artery endarterectomy: A safe and durable technique for the treatment of iliac artery occlusive disease. Journal of vascular surgery 2020. link 4 Lee MS, Martinsen BJ, Hollowed J, Heikali D, Mustapha J, Adams G et al.. Acute procedural outcomes of orbital atherectomy for the treatment of iliac artery disease: Sub-analysis of the CONFIRM registries. Cardiovascular revascularization medicine : including molecular interventions 2018. link 5 Holden A, Merrilees S, Buckley B, Connor B, Colgan F, Hill A. First-in-Human Experience With the Gore Balloon-Expandable Covered Endoprosthesis in Iliac Artery Occlusive Disease. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2017. link 6 Park JK, Oh SJ, Shin JY. Delayed rupture of the iliac artery after percutaneous angioplasty. Annals of vascular surgery 2014. link 7 Rodriguez HE, Eggener SE, Podbielski FJ, Brown AM, Amble S, Clark ET et al.. Occlusion of an intraluminal endovascular stent graft after treatment of a ureteral-iliac artery fistula. Urology 2002. link01902-7) 8 Karkos CD, Oshodi TO, Vimalachandran D, Abraham JS, Adiseshiah M. Internal iliac aneurysm rupture into the rectum following endovascular exclusion: an unusual cause of massive lower gastrointestinal bleeding. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2002. link 9 Cambria RA, Farooq MM, Mewissen MW, Freischlag JA, Seabrook GR, Crain MR et al.. Endovascular therapy of iliac arteries: routine application of intraluminal stents does not improve clinical patency. Annals of vascular surgery 1999. link 10 Gohji K, Uehara H, Takagi S, Arakawa S, Matsumoto O, Kamidono S. Ureteral stenosis secondary to common iliac aneurysm: a case report and review of the literature in Japan. Hinyokika kiyo. Acta urologica Japonica 1988. link 11 Conrad C, Corfitsen MT, Fries J. Sex-linked pattern of collaterals in iliac artery occlusive disease. Acta radiologica: diagnosis 1986. link

Fracture of iliac crest