Introduction
An unstable pelvic ring fracture requires surgical stabilization. The anterior ilioinguinal approach to the sacroilliac (SI) joint is recommended for a vertically, posteriorly, or laterally displaced hemipelvis because it allows for a direct visualization and it affords for an anatomic reduction of the SI joint. Other indications for use of the anterior approach include the need for fixation of associated acetabular, iliac wing, or symphyseal fractures. This technique is not applicable for fractures of the sacrum because of the proximity to the L5 nerve root. Biomechanical data supports the use of anterior plating for rigid osseous stabilization of the SI joint. Other techniques of internal fixation include transiliac screws, posterior tension band plate, and sacral bars. These methods place important neurologic and vascular structures at risk. Further, a posterior approach has inherent difficulty in reducing a SI disruption and may cause a higher incidence of skin necrosis. This article describes the advantages and the technique of anterior stabilization of the SI joint in the management of an unstable pelvic ring fracture.