Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with a bump placed beneath the pelvis to facilitate reduction, while maintaining distal femoral skeletal traction.

Anatomical surgical approach:  The left sacral fracture was addressed first via percutaneous placement of iliosacral screws under fluoroscopic guidance. An anterior approach to the iliac wing was performed via a longitudinal incision along the crista iliaca, subperiosteal dissection to expose the fractura alae ossis ilii, followed by debridement, reduction, and temporary clamping. Definitive fixation was achieved with two 7mm diameter cannulated fully threaded medullary screws placed across the iliac crest and pelvic brim into the corpus ossis ilii. The left ramus ossis pubis fracture and overall cingulum pelvicum were assessed intraoperatively with fluoroscopy for residual instability.

Intraoperatively, minimal residual deformity of the left hemipelvis was noted after traction and positioning. The sacral fracture was stabilized first with iliosacral screws. The anterior iliac exposure allowed for direct visualization, cleaning, reduction, and clamping of the iliac wing fracture prior to screw fixation. After fixation, intraoperative fluoroscopic stress examination demonstrated stability of the left pubic ramus fracture and overall pelvic ring, obviating the need for further anterior fixation.

Postoperative protocol:   The patient was restricted to bed-to-chair transfers and non-weightbearing activity for the first five weeks postoperatively.

Follow up:   Not specified

Orthopaedic implants used:   Two 7mm diameter cannulated fully threaded medullary screws (iliac crest and pelvic brim), percutaneous iliosacral screw(s).