Surgical Discussion

Patient positioning:  The patient was initially positioned supine for the AIP approach to facilitate access to the anterior structures. Following this, the patient was repositioned prone for the KL approach to address the posterior elements.

Anatomical surgical approach:  The anterior intrapelvic approach involved an incision along the iliac crest extending towards the pubic symphysis, allowing access to the quadrilateral surface and medial acetabulum. The Kocher-Langenbeck approach was performed with a longitudinal incision over the greater trochanter, extending distally along the femoral shaft, providing access to the posterior column and wall.

The surgical strategy was dictated by the need to address the large free articular fragment through the AIP approach first. This fragment was found to be completely free from its cortical attachment, complicating reduction efforts. The posterior column and wall were then addressed via the KL approach, where reduction of the impaction and stabilization of the column were achieved. Despite efforts, minor articular malreduction was noted postoperatively.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing on the affected limb for 8 weeks, followed by gradual weight-bearing as tolerated. Range of motion exercises were initiated early to prevent joint stiffness.

Follow up:   Not specified

Orthopaedic implants used:   Pelvic reconstruction plates, screws for fixation of posterior column and wall fragments.