BACKGROUND: Iliac wing fractures have received little attention in the literature. Commonly occurring after a direct blow, they are rotationally and vertically stable. However, one must be aware of their potential for major morbidity including soft tissue, abdominal organ, and vascular lesions. This study examines the incidence, radiographic findings, soft tissue injuries, and complications associated with isolated iliac wing fractures. METHODS: Retrospective review between 2003 and 2006 of a consecutive series of 450 polytraumatized patients treated in a level-1 University trauma center. Hospital charts and radiographs were reviewed and all patients with an isolated iliac wing fracture were requested to return for a clinical and radiologic examination. RESULTS: One hundred twenty patients had major pelvic trauma. Only 10 sustained a fracture limited to the iliac wing, all after high-energy trauma. Nine of 10 patients sustained a total of 36 additional injuries involving head, thorax, spine, abdomen, urologic, and orthopedic systems. Only two patients underwent internal fixation of their fracture, one because of the fracture compressing the bowel and the other because of a very large rotated iliac wing fragment. Two patients with open fractures were treated with irrigation and debridement and no internal fixation. CONCLUSIONS: An isolated iliac wing fracture not compromising the stability of the pelvic ring may be interpreted as a benign injury. However, serious and potentially life-threatening associated injuries may be present requiring emergency abdominal, vascular, or neurologic surgery. A thorough search for such injuries is critical. Most iliac wing fractures can be managed nonoperatively.