Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent table to facilitate anterior access, with the potential for repositioning to lateral decubitus if necessary for posterior acetabular access.

Anatomical surgical approach:  The surgical approach commenced with an ilioinguinal incision, providing access to the anterior column of the pelvis. Dissection proceeded through the external oblique aponeurosis, with careful retraction of the neurovascular structures to expose the fracture site. For the acetabular component, a Kocher-Langenbeck approach was utilized, involving an incision along the posterior aspect of the hip, with detachment of the gluteus maximus and exposure of the posterior column.

The operative procedure was challenging due to the complexity and comminution of the fracture fragments. Meticulous reduction techniques were employed, utilizing a combination of direct and indirect reduction methods. Temporary fixation with K-wires facilitated stabilization during definitive fixation. The use of intraoperative fluoroscopy ensured accurate alignment and fixation of both pelvic and acetabular components.

Postoperative protocol:   Postoperatively, the patient was placed on a non-weight-bearing protocol for 8 weeks, with gradual progression to partial weight-bearing as tolerated. Early mobilization with physiotherapy focused on maintaining range of motion and preventing joint stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   Pelvic reconstruction plate, acetabular reconstruction plate, K-wires for temporary fixation.