Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent table, with no traction applied.

Anatomical surgical approach:  A standard ilioinguinal approach was performed, sequentially developing the iliac, middle, and intrapelvic windows. Subperiosteal dissection exposed the fractured anterior column and quadrilateral plate. The fracture planes were meticulously debrided of hematoma and interposed tissue. Bone clamps were applied to achieve reduction of the anterior column and posterior hemi-transverse fragments. Buttressing plates were contoured and applied to the pelvic brim and quadrilateral surface, with interfragmentary lag screws placed through the plates to secure the reduction while maintaining clamp control.

Surface renderings from preoperative imaging facilitated intraoperative correlation between radiographic and fluoroscopic views, aiding in precise interpretation of fragment orientation during reduction. The use of focal plates allowed for maintenance of provisional reductions with bone holding clamps during definitive fixation. Restoration of radiographic lines was confirmed on intraoperative AP fluoroscopy, while postoperative axial CT demonstrated successful central dome repair with a residual edge crush defect at the dome margin.

Postoperative protocol:   Postoperatively, early passive range of motion exercises were initiated with toe-touch weight bearing for 8 weeks. Progressive weight bearing was advanced according to radiographic evidence of healing.

Follow up:   Not specified

Orthopaedic implants used:   Focal buttressing plates, interfragmentary lag screws