Bilateral Acetabular T-Type Fractures with Associated Posterior Pelvic Ring Disruptions Managed by Staged Percutaneous and Open Fixation
Score and Comment on this Case
Clinical Details
Clinical and radiological findings: Adult male sustained a crush injury from a half-ton object, resulting in hemodynamic instability despite initial resuscitation and pelvic binder application. Clinical and radiological assessment revealed bilateral acetabular T-type fractures (AO/OTA 62-B2 bilaterally) with associated posterior pelvic ring injuries, including left sacroiliac (SI) joint disruption. Oblique CT renderings demonstrated acetabular fracture details and displacement patterns, with both sides exhibiting T-type configurations and notable posterior pelvic ring involvement.
Preoperative Plan
Planning remarks: The preoperative plan included initial stabilization of the right posterior pelvic ring and anterior column (AC) portion of the right acetabular fracture, application of a compressive external fixation frame, and percutaneous lag screw fixation of the left SI iliac injury. Bilateral iliosacral screws were planned with intentional thread placement across both SI joints for enhanced fixation. Subsequent procedures included addition of a transiliac-transsacral screw, left AC screw, removal of the external frame, prone positioning, and bilateral posterior column (PC) lag screw fixation.
Surgical Discussion
Patient positioning: Supine positioning for initial percutaneous and anterior column interventions; prone positioning for subsequent bilateral posterior column lag screw fixation.
Anatomical surgical approach: Percutaneous iliosacral screw fixation was performed via small stab incisions over the posterior superior iliac spine, utilizing fluoroscopic guidance to traverse the sacroiliac joint and secure the posterior pelvic ring. Anterior column screws were placed percutaneously along the pelvic brim, targeting the anterior column of the acetabulum. A transiliac-transsacral screw was inserted from the lateral aspect of one ilium, traversing the sacrum to the contralateral ilium. Posterior column lag screws were placed with the patient prone, utilizing a direct posterior approach to the ischial tuberosity and sciatic notch region for accurate trajectory into the posterior column.
Operative remarks:Hemodynamic instability necessitated urgent angiographic embolization prior to definitive fixation. The staged approach allowed for physiologic optimization before sequential stabilization of complex bilateral acetabular and pelvic ring injuries. Bilateral iliosacral screw threads were intentionally laced across both SI joints to maximize purchase in compromised bone. The compressive external frame provided temporary stabilization during early fixation stages and was removed once definitive internal fixation was achieved. Accurate coordination and measurement of interventions were emphasized as critical for optimal patient outcomes in complex pelvic trauma.
Postoperative protocol: Early postoperative protocol included restricted weight bearing on both lower extremities, deep vein thrombosis prophylaxis, and progressive mobilization as tolerated. Range of motion exercises for hip and knee joints were initiated within pain limits, with gradual advancement to partial weight bearing based on radiographic evidence of healing.
Follow up: Not specified
Orthopaedic implants used: Bilateral iliosacral cannulated screws, percutaneous anterior column screws (right and left), transiliac-transsacral screw, bilateral posterior column lag screws, temporary external compression frame
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02 Sep 2025
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Full Citation
Cite this article:
Routt, ML. (2025). Bilateral Acetabular T-Type Fractures with Associated Posterior Pelvic Ring Disruptions Managed by Staged Percutaneous and Open Fixation. Journal of Orthopaedic Surgery and Traumatology. Case Report 37691517 Published Online Sep 02 2025.