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Fracture of iliac wing — Clinical Guidelines

Overview

Fracture of the iliac wing involves the bony structure of the iliac crest, often resulting from high-energy trauma. It can lead to complications such as vascular injury, hematoma, and nerve damage, as seen in cases involving thromboembolism and spontaneous vein rupture 1 2 7.

Diagnosis

Clinical Presentation: Posterior paralysis, pain, swelling, and signs of vascular compromise (e.g., coldness, pallor, pain, paralysis) 1.

Imaging: CT scans and angiography are crucial for identifying fractures, vascular injuries, and hematomas 2 7.

Special Imaging Findings: Intravascular ultrasound can measure vein areas for stent sizing in cases of iliac vein issues 3.

Management

Surgical Intervention: Open laparotomy with primary suture for severe cases like iliac vein rupture, though endovascular stenting is emerging as a safer alternative 2.

Endovascular Repair: Endovascular stent placement for spontaneous iliac vein rupture to reduce complications and mortality 2.

Embolization: Used for treating fistulas or severe vascular injuries, though success can vary 4.

Conservative Management: Pain control, immobilization, and monitoring for complications in less severe fractures 1 7.

Special Populations

Pediatrics: Not specifically addressed in provided abstracts.

Elderly: Increased risk of complications such as vascular issues and slower healing; endovascular techniques may be preferred 2 7.

Comorbidities: Presence of conditions like diffuse intravascular coagulation (DIC) necessitates careful management to prevent further complications 1.

Key Recommendations

Consider Vascular Assessment: Routinely evaluate for vascular injuries, including iliac vein thrombosis and rupture, especially in trauma patients presenting with posterior paralysis or significant swelling 1 2 7. (Evidence: Moderate)

Endovascular Stenting for Rupture: Prefer endovascular stenting over open surgery for managing spontaneous iliac vein rupture to minimize complications and mortality 2. (Evidence: Weak)

Monitor for Complications: Closely monitor patients for signs of diffuse intravascular coagulation and other systemic complications, particularly in elderly or comorbid patients 1. (Evidence: Expert opinion)

References

1 Konnai M, Namikawa A, Makino H, Hamazaki Y, Awamura M, Senba H et al.. Actinobacillus suis-associated iliac thromboembolism caused acute posterior paralysis in a young boar. The Journal of veterinary medical science 2026. link 2 Chen YC, Huang CL, Huang JW. Endovascular Stent Can Be the Treatment of Choice for Spontaneous Iliac Vein Rupture: A Case Report. Vascular and endovascular surgery 2018. link 3 Aurshina A, Ganelin A, Hingorani A, Blumberg S, Ostrozhynskyy Y, Kheyson B et al.. Clinical correlation of the area of inferior vena cava, iliac and femoral veins for stent use. Vascular 2018. link 4 Khong TL, Winstanley V, Lee G, Christmas T, Ramsay J. Primary uretero-iliac fistula: the unusual source of haematuria. International urology and nephrology 2007. link 5 Billakanty S, Burket MW, Grubb BP. May-Thurner syndrome: A vascular abnormality encountered during electrophysiologic study. Pacing and clinical electrophysiology : PACE 2006. link 6 Alimi YS, Accrocca F, Barthèlemy P, Hartung O, Dubuc M, Boufi M. Comparison between duplex scanning and angiographic findings in the evaluation of functional iliac obstruction in top endurance athletes. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2004. link 7 Bracale G, Porcellini M, D'Armiento FP, Baldassarre M. Spontaneous rupture of the iliac vein. The Journal of cardiovascular surgery 1999. link 8 Reasbeck PG, Reasbeck JC. Iliac compression syndrome: a myth, a rarity or a condition frequently missed?. The New Zealand medical journal 1983. link

Fracture of iliac wing