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Carlos A. Encinas-Ullán Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain

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José M. Martínez-Diez Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain

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E. Carlos Rodríguez-Merchán Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain

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, avoiding large incisions ( Fig. 1 ), 2 cm posterior to the antero-superior iliac spine to avoid injury to the lateral femoral cutaneous nerve. The pin is inserted between the inner and outer table of the ilium directed towards the sacroiliac joint. If the

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Martin C Jordan Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Würzburg, Germany
TraumaEvidence @ German Society for Trauma Surgery, Berlin, Germany

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Konrad F Fuchs Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Würzburg, Germany

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Steven C Herath Department for Traumatology and Reconstructive Surgery, BG Trauma Center, University of Tübingen, Tübingen, Germany

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Joachim Windolf TraumaEvidence @ German Society for Trauma Surgery, Berlin, Germany
Department of Orthopaedic and Traumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

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Rainer H Meffert Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Würzburg, Germany

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Anne Neubert TraumaEvidence @ German Society for Trauma Surgery, Berlin, Germany
Department of Orthopaedic and Traumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

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Introduction Open-book pelvic injuries are often caused by an anterior impact that leads to the external rotation of one or both hemipelves, resulting in the rupture of the symphysis pubis. The sacroiliac joint acts as a fulcrum of rotation

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Juan Ramón Cano Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Malaga, Spain

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José Manuel Bogallo Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Malaga, Spain

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Alicia Ramirez Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Malaga, Spain

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Enrique Guerado Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Malaga, Spain

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sacroiliac – anterior (ASIL) and posterior) and long ligaments (sacro-sciatic ligament (SSL) and sacro-ischial ligament (SIL)). Anteriorly both iliac bones are directly joined together in the symphysis pubis (SP) by an amphiarthrosis joint with potent

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Pedro Cano-Luís Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Spain

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Miguel Ángel Giráldez-Sánchez Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Spain

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Pablo Andrés-Cano Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Spain

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cases posterior pain may appear due to osteoarthritic changes in the sacro-iliac joint. 23 It is important to differentiate true pelvic pain from mechanical low back pain secondary to a compensatory scoliotic curve of the lumbosacral spine, and from

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Emmanuele Santolini Academic Unit of Trauma and Orthopaedics, University of Genoa, Italy
Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, UK

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Nikolaos K. Kanakaris Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, UK

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Peter V. Giannoudis Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, UK
NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK

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, in particular with respect to the L5–S1 facet, which together with lumbosacral posterior ligaments and sacroiliac joints, determines spondilopelvic stability. 28 He identified longitudinal transforaminal fractures and divided them into three

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Holger Keil BG Trauma Center Ludwigshafen, Germany

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Nils Beisemann BG Trauma Center Ludwigshafen, Germany

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Benedict Swartman BG Trauma Center Ludwigshafen, Germany

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Sven Yves Vetter BG Trauma Center Ludwigshafen, Germany

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Paul Alfred Grützner BG Trauma Center Ludwigshafen, Germany

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Jochen Franke BG Trauma Center Ludwigshafen, Germany

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the obese, this causes reduction of contrast, so the assessment of the bony structures is hindered. Figure 2 shows an intra-operative lateral view of the sacrum with two screws fixating the sacroiliac (SI) joints on both sides. Due to low contrast

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Arvin Eslami Bone and Joint reconstruction research center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

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Mohammadreza Chehrassan Bone and Joint reconstruction research center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

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Shaya Alimoghadam Bone and Joint reconstruction research center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

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Karim Pisoudeh Bone and Joint reconstruction research center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

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Amir Kasaeian Digestive Oncology Research Center, Digestive Diseases Research Institute; Research Center for Chronic Inflammatory Diseases; Clinical Research Development Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

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Omid Elahifar Bone and Joint reconstruction research center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

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.0%) 1 (100%) 0 (0.0%) 1 (100%)  External fixator and sacroiliac fixation 1 (100%) 0 (0.0%) 1 (100%) 0 (0.0%) 1 (100%)  ORIF of symphysis and sacroiliac joint 3 (100%) 0 (0.0%) 0 (0.0%) 3 (100%) 3 (100%)  External

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Tim Pohlemann Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany

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Steven C. Herath Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany

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Benedikt J. Braun Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany

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Mika F. Rollmann Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany

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Tina Histing Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany

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Antonius Pizanis Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany

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with the urinary bladder. The internal obturator muscle is then elevated by subperiosteal dissection and the infrapectineal bone can be exposed as far posterior as the sacroiliac joint. Fig. 3 Pararectus approach. After incising the aponeurosis of

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Markus A. Küper BG Trauma Center, Department for Traumatology and Reconstructive Surgery, Eberhard Karls University, Tübingen, Germany

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Alexander Trulson BG Trauma Center, Department for Traumatology and Reconstructive Surgery, Eberhard Karls University, Tübingen, Germany

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Fabian M. Stuby BG Trauma Center, Department for Traumatology, Orthopedics and Surgery, Murnau am Staffelsee, Germany

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Ulrich Stöckle BG Trauma Center, Department for Traumatology and Reconstructive Surgery, Eberhard Karls University, Tübingen, Germany

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. Anatomy and biomechanics of the pelvic ring The pelvic ring consists of the sacrum and the two hip bones (each one of them consisting of an ischium, ilium and pubic bone) which are connected by three joints, namely two sacroiliac (SI) joints between the

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Cora Rebecca Schindler Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

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Ramona Sturm Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

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Jason Alexander Hörauf Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

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Ingo Marzi Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

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Philipp Störmann Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

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reduction and internal fixation. The pelvic C-clamp can be used posteriorly for the direct reduction of vertically and rotationally unstable fractures. By exerting transverse compression over the sacroiliac joint, the basis for effective pelvic tamponade

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