Surgical Discussion

Patient positioning:  The patient was positioned supine with a sacral bump to facilitate reduction, and left-sided longitudinal traction was applied to aid in fracture alignment.

Anatomical surgical approach:  The surgical approach involved a direct anterior midline exposure to the symphysis pubis, followed by subperiosteal dissection to expose the disrupted SP. The ilioinguinal approach was utilized for the iliac fracture, with careful elevation of the abdominal musculature from the iliac crest and pelvic brim. The iliac fracture was reduced using a Farabeuf clamp at the linea terminalis (brim) and a tenaculum at the crista iliaca. The symphysis pubis was reduced with a tenaculum clamp.

Accurate anatomical reduction was achieved at both the iliac crest and pelvic brim using direct clamp application. Stable fixation was performed at each site according to biomechanical principles, utilizing plates and/or screws as indicated by fragment size and displacement. For closure of the symphysis pubis, interrupted 2-0 Vicryl pop-off sutures on a non-cutting needle were used for the midline portion, with additional 0 Vicryl sutures for reinforcement at the tendon insertion area.

Postoperative protocol:   Postoperative rehabilitation protocol included initial bed rest with protected weight bearing, progressing to partial weight bearing as tolerated by 6 weeks, and full weight bearing by 10–12 weeks postoperatively, depending on radiographic evidence of healing and clinical stability.

Follow up:   Not specified

Orthopaedic implants used:   Pelvic reconstruction plate(s), cortical screws, 2-0 Vicryl sutures, 0 Vicryl sutures