Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent operating table to facilitate fluoroscopic imaging and access to both anterior and posterior aspects of the pelvis.

Anatomical surgical approach:  A posterior approach was utilized for stabilization of the pelvic ring. Percutaneous screw fixation was performed on the right hemipelvis through small incisions overlying the posterior superior iliac spine and directed towards the sacroiliac joint. The left SI joint was similarly accessed for screw placement following stress testing.

Intraoperative findings confirmed significant instability of the left SI joint upon stress testing after stabilization of the right side. A screw was placed across the left SI joint to achieve stabilization. Further examination under anesthesia demonstrated no motion or deformity in the anterior ring upon lateral compression, obviating the need for anterior fixation. The concept of a progressive EUA was pivotal in guiding the selective fixation strategy, minimizing unnecessary surgical intervention and associated risks.

Postoperative protocol:   Postoperatively, the patient was managed with partial weight-bearing restrictions on the affected side for six weeks, progressing to full weight-bearing as tolerated thereafter. Physical therapy focused on maintaining range of motion and strengthening exercises commenced immediately.

Follow up:   Not specified.

Orthopaedic implants used:   Percutaneous sacroiliac screws.