Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent table to facilitate fluoroscopic imaging and allow access for both percutaneous and open approaches to the pelvis.

Anatomical surgical approach:  A standard anterior ilioinguinal approach was utilized for the right iliac fracture. Dissection proceeded through the skin and subcutis, with identification and protection of the lateral femoral cutaneous nerve. The external oblique aponeurosis was incised, and the iliacus muscle was elevated subperiosteally from the internal iliac fossa to expose the fracture site. Reduction was achieved under direct visualization, followed by internal fixation with a contoured plate and pelvic brim cancellous screws, ensuring all implants were contained within the osseous fixation pathway. The left sacral fracture was stabilized percutaneously under fluoroscopic guidance.

Bilateral distal femoral traction resulted in excellent reduction of the sacral fracture but did not adequately reduce the iliac displacement. Percutaneous fixation of the sacrum was performed first, followed by open reduction of the iliac fracture. Intraoperative imaging confirmed that all implants were fully contained within the available osseous corridors, avoiding extraosseous penetration. The complexity of the iliac fracture required careful anatomical reduction and implant placement along the pelvic brim.

Postoperative protocol:   Postoperatively, the patient was maintained non-weight bearing on the affected side for six weeks, with progressive mobilization as tolerated. Early passive and active-assisted range of motion exercises for the hip and knee were initiated immediately postoperatively.

Follow up:   Not specified

Orthopaedic implants used:   Pelvic brim contoured plate, cancellous screws, percutaneous sacral screw(s)