Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table, with provisions made for intraoperative fluoroscopic imaging to guide percutaneous screw placement and reduction maneuvers.

Anatomical surgical approach:  A lateral window approach was utilized to access the anterior column. Schanz pins were strategically placed in the gluteal pillar and LC2 corridor to facilitate reduction of the anterior column at the iliac crest exit and brim. A crest plate was applied to maintain peripheral reduction, followed by placement of an LC2 style screw for compression. Additional fixation included an antegrade ramus lag screw, a posterior column lag screw, another LC2 style screw, and percutaneous right SI joint screw fixation.

The surgeon noted that the lateral window approach provided a favorable balance between invasiveness and reduction quality, offering a lower infection risk compared to more extensive approaches such as ilioinguinal or Stoppa. The use of column screws minimized surface implants, further reducing infection risk. In a less obese patient, an anterior intrapelvic (Stoppa) approach might have been employed to enhance reduction quality.

Postoperative protocol:   Postoperative rehabilitation focused on minimizing weight-bearing stress on the pelvis. Initial non-weight-bearing status was maintained, with gradual progression to partial weight-bearing as tolerated, considering the patient's spinal cord injury and overall condition.

Follow up:   Not specified.

Orthopaedic implants used:   Partially threaded 7.0mm screws, Schanz pins, crest plate, LC2 style screws, antegrade ramus lag screw, posterior column lag screw.