Surgical Discussion

Patient positioning:  Supine position on a radiolucent table, allowing unobstructed fluoroscopic access to the pelvis in multiple planes.

Anatomical surgical approach:  Percutaneous approach: Small stab incisions were made over the crista iliaca and sacral entry points as determined by preoperative imaging. Under fluoroscopic guidance, guidewires were advanced across the sacroiliac joint and sacral ala as indicated. Cannulated screws were inserted percutaneously to stabilize the unstable posterior pelvic ring and rami fractures.

Intraoperative assessment confirmed instability at the posterior pelvic ring with manual stress testing under fluoroscopy. Reduction was achieved with gentle manipulation and maintained during percutaneous screw insertion. The use of intraoperative inlet and outlet views was critical for accurate screw placement and confirmation of reduction. The minimally invasive technique minimized additional soft tissue trauma in this polytrauma patient.

Postoperative protocol:   Early mobilization as tolerated with protected weight bearing for 6–8 weeks. Progressive increase in activity based on radiographic evidence of healing and clinical improvement in pain. Emphasis on deep vein thrombosis prophylaxis and pulmonary hygiene.

Follow up:   Not specified

Orthopaedic implants used:   Cannulated percutaneous pelvic screws