Journal of Musculoskeletal Trauma

Review Article

Combined acetabular and pelvic ring injuries: a reference-frame algorithm for definitive fixation sequencing: Jeong-Hyun Koh, Seungyeob Sakong; Received January 8, 2026 Accepted January 14, 2026 Published online April 9, 2026; DOI: https://doi.org/10.12671/jmt.2026.00031 [Epub ahead of print]

Abstract PDF: Combined acetabular and pelvic ring injuries are not simply “two fractures in one patient.” Reduction and fixation of one component can alter the alignment and reducibility of the other, rendering operative sequencing a primary decision variable rather than a secondary consideration. These injuries typically result from high-energy trauma, frequently occur in patients with polytrauma, and are further influenced by physiological tolerance and the feasibility of available operative corridors. The existing evidence base remains constrained by retrospective study designs, inconsistent definitions, variable classification systems, and heterogeneous outcome reporting, all of which limit the strength of comparative recommendations. This state-of-the-art review presents a surgeon-facing, algorithmic approach grounded in a reference-frame mindset. We emphasize computed tomography (CT)-based mapping and the use of consistent terminology to characterize acetabular morphology, pelvic ring instability, deformity vectors, suspicion of mechanical coupling, and feasible operative corridors. Mechanically connected acetabular and pelvic ring injuries (MCAPI) are introduced as a working framework for identifying patterns in which reduction or fixation of one injury predictably influences the other. In cases of suspected MCAPI, a posterior ring-based sequence is generally preferred, typically consisting of posterior ring reduction and fixation, definitive acetabular reconstruction, and subsequent anterior ring fixation. We propose an explicit intraoperative “GO/NO-GO” checkpoint (reference acceptable, stable, corridors feasible) to prevent acetabular reconstruction on a moving target. Acetabulum-first strategies may be appropriate only in selected anteroposterior compression- type configurations in which acetabular fixation plausibly restores sacroiliac congruency and posterior stabilization remains technically feasible. We summarize key outcome domains and complication patterns, highlighting hip dislocation as an important risk factor associated with both neurologic deficits and overall complications. Standardized CTbased definitions and outcome instruments, together with multicenter cohorts employing predefined decision pathways, are required to test sequencing strategies and to determine whether improved radiographic reduction translates into durable functional benefit.

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Case Report

Surgical Correction and Osteosynthesis for Cranial Displaced Pelvic Nonunion: Technical Note and Two Cases Report Regarding Anterior Correction and Osteosynthesis Following Posterior Release: Kwang Cheon Choi, Ji Yoon Ha, Weon Yoo Kim; J Korean Fract Soc 2014;27(2):151-156. Published online April 30, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.2.151

Abstract PDF: Nonunion of an unstable pelvic fracture with cranial displacement pelvic surgery is technically difficult due to a large amount of bleeding and the risk of nerve damage. In addition, surgical correction of leg length discrepancy by reduction of a dislocated sacroiliac joint is in high demand. Nevertheless, when a patient is strongly disabled by a pelvic deformity, surgical correction may be necessary. Two patients with pelvic deformity were treated successfully by surgical correction and osteosynthesis.

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