Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent operating table to facilitate fluoroscopic imaging in multiple planes (anteroposterior, inlet, and outlet views) for accurate guide pin and device placement.

Anatomical surgical approach:  Percutaneous access was established over the dorsal aspect of the pelvis. Small incisions were made lateral to the sacrum, and soft tissue dissection was performed to the level of the os sacrum. Guide pins were advanced under fluoroscopic control along the oblique upper sacral corridors bilaterally. The cannulated CurvaFix device was inserted over each guide pin, articulated to match the oblique fracture pathway, and subsequently locked in situ according to the manufacturer’s specifications.

The articulated nature of the CurvaFix device allowed precise accommodation of the complex oblique upper sacral fracture pathways bilaterally. Percutaneous technique minimized soft tissue disruption and surgical morbidity. Postoperative CT imaging confirmed satisfactory device placement and fracture reduction. The achieved stability provided immediate pain relief, reduced or eliminated narcotic requirements, and enabled early mobilization. Surgeons with experience in device removal have reported no technical difficulties.

Postoperative protocol:   Early mobilization was initiated postoperatively as tolerated by the patient, with weight bearing as permitted by comfort and stability. Standard deep vein thrombosis prophylaxis and physiotherapy were instituted. No external immobilization was required.

Follow up:   Not specified

Orthopaedic implants used:   CurvaFix intramedullary fixation device