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19 Jul 2025
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LC1 Pelvic Fracture with Instability Requiring Surgical Intervention

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Clinical Details

Clinical and radiological findings:  A 26-year-old female involved in a high-speed motor vehicle collision presented with multiple injuries, including an open abdominal injury, but no lower extremity orthopedic issues. Radiological assessment revealed a complete sacral fracture, bilateral ramus fractures, and minimal resting deformity. The fracture pattern was classified as LC1 according to the Young and Burgess classification, indicating a lateral compression injury. The primary concern was the potential instability of the pelvic ring.

Preoperative Plan

Planning remarks:  The preoperative plan involved performing an examination under anesthesia (EUA) to assess pelvic stability. If instability was confirmed, the surgical plan included the application of an external fixator for reduction and stabilization, followed by the insertion of an iliosacral screw to secure the sacral fracture.

Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent operating table to facilitate both the EUA and subsequent surgical intervention.

Anatomical surgical approach:  application of the external fixator. Percutaneous insertion of the iliosacral screw was performed under fluoroscopic guidance to stabilize the sacral fracture.

Operative remarks: 

During the EUA, manual compression through the greater trochanters was applied to assess pelvic stability. The hemipelvis demonstrated internal rotation instability, which reduced with external rotation, confirming the need for surgical stabilization. The external fixator was applied to achieve reduction, and an iliosacral screw was inserted to maintain stability. The subjective nature of determining instability during EUA was noted, highlighting the need for standardized assessment protocols.

Postoperative protocol:   Postoperatively, the patient was instructed to maintain non-weight bearing on the affected side for six weeks, with progressive weight-bearing as tolerated thereafter. Physical therapy focused on maintaining range of motion and strengthening exercises.

Follow up:   Not specified

Orthopaedic implants used:   External fixator, Iliosacral screw

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