Surgical Discussion

Patient positioning:  Supine position on a radiolucent table to facilitate intraoperative fluoroscopic imaging and access to the pelvic region.

Anatomical surgical approach:  A percutaneous approach was utilized for the insertion of the transiliac transsacral lag screw and the fully threaded iliosacral screw. Fluoroscopic guidance was employed to ensure accurate placement of the screws across the sacroiliac joint and symphysis pubis.

Internal rotation taping of the lower extremities improved the reduction of the symphysis pubis. Sequential outlet pelvic intraoperative fluoroscopic images confirmed further indirect compression and reduction of the pubis upon tightening of the transiliac transsacral lag screw. The addition of a fully threaded iliosacral screw provided supplementary fixation, maintaining reduction after removal of the taping. This technique was chosen due to chronic issues that precluded routine pubic ORIF, demonstrating the efficacy of closed reduction with internal fixation in specific clinical scenarios.

Postoperative protocol:   Postoperative rehabilitation included protected weight-bearing with gradual progression as tolerated. Emphasis was placed on early mobilization within pain limits to prevent complications associated with prolonged immobility.

Follow up:   Not specified

Orthopaedic implants used:   Transiliac transsacral lag screw, fully threaded iliosacral screw.