Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent operating table to facilitate anterior pelvic access and intraoperative fluoroscopic imaging.

Anatomical surgical approach:  A classical ilioinguinal approach was performed, with two windows developed: the lateral window between the musculus sartorius and musculus tensor fasciae latae, and the middle window between the musculus iliopsoas and external iliac vessels. Subcutaneous dissection was performed to create two opposing slabs of adipose tissue ("walls of fat"), minimizing random subcutaneous incisions. The anterior column fragment was exposed, reduced anatomically, and fixed under direct visualization. At a subsequent stage, percutaneous reduction and fixation of the posterior column were performed under fluoroscopic guidance, with careful trajectory planning to avoid interference from previously placed AC implants.

The operative sequence was dictated by the patient’s overall clinical status, necessitating staged management. Intraoperative attention was paid to implant placement during AC fixation to preserve access for subsequent percutaneous PC fixation. Postoperative CT confirmed satisfactory reduction and fixation of both columns, with appropriate implant positioning and no evidence of neurovascular compromise or significant soft tissue complications.

Postoperative protocol:   Early passive range of motion exercises were initiated postoperatively. Weight bearing was restricted according to fracture stability and healing progression, with toe-touch weight bearing for 6–8 weeks, followed by gradual advancement to partial and then full weight bearing as radiographic union permitted.

Follow up:   Not specified

Orthopaedic implants used:   3.5 mm reconstruction plates (anterior column), cannulated screws (posterior column, percutaneous technique)