Surgical Discussion

Patient positioning:  The patient was positioned prone on a radiolucent operating table to facilitate posterior pelvic access and allow intraoperative fluoroscopic imaging in multiple planes.

Anatomical surgical approach:  A Kocher-Langenbeck approach was performed: a longitudinal incision centered over the greater trochanter, with dissection through the gluteal fascia and splitting of the gluteus maximus muscle. The short external rotators were identified and detached from their femoral insertions, with care to protect the sciatic nerve. Subperiosteal elevation of the piriformis and obturator internus tendons exposed the posterior column and wall of the acetabulum. The comminuted posterior wall fragments were identified; the caudal fragment was noted to be devoid of soft tissue attachments. The transverse fracture plane was visualized, debrided, and reduced under direct vision.

The transverse fracture was manipulated and temporarily stabilized using a reduction clamp applied across the fracture plane. Under biplanar fluoroscopic guidance, a cannulated cancellous lag screw was percutaneously inserted to achieve interfragmentary compression across the transverse component. The reduction clamp was then removed. Posterior wall fragments were anatomically reduced and stabilized with contoured buttress plates spanning both the posterior wall and providing additional stabilization to the transverse component. Postoperative CT confirmed satisfactory reduction and fixation of both acetabular columns and restoration of articular congruity.

Postoperative protocol:   Postoperatively, skeletal traction was discontinued. The patient was maintained non-weight bearing on the affected limb for 8 weeks, with early passive range of motion exercises initiated at 48 hours post-surgery. Progressive weight bearing was introduced after radiographic evidence of healing at 8–10 weeks.

Follow up:   Not specified

Orthopaedic implants used:   Cannulated cancellous lag screw; contoured acetabular buttress plates