Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent table to facilitate fluoroscopic imaging in multiple planes.

Anatomical surgical approach:  Percutaneous approach to the superior pubic ramus under fluoroscopic guidance, with a small stab incision over the entry point at the pubic tubercle. For the posterior ring, a percutaneous approach was utilized, targeting the sacroiliac region for cannulated screw placement under fluoroscopic control.

Closed reduction was achieved under fluoroscopic guidance, with satisfactory alignment of both anterior and posterior elements. A 4.5mm cortical screw was placed percutaneously across the superior pubic ramus fracture, and a 7mm cannulated cancellous screw was inserted across the posterior pelvic ring injury. No intraoperative complications were encountered. Implant removal was performed 10 months postoperatively without incident.

Postoperative protocol:   Early mobilization was encouraged with protected weight bearing for 6 weeks, followed by progression to full weight bearing as tolerated. No bracing was utilized.

Follow up:   At 15 years of age, the patient is completely asymptomatic, fully functional, and participates in high school soccer without limitation.

Orthopaedic implants used:   4.5mm cortical screw (superior pubic ramus), 7mm cannulated cancellous screw (posterior pelvic ring).