Surgical Discussion

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

Anatomical surgical approach:  A percutaneous approach was utilized for the pubic ramus fixation. A small stab incision was made over the anterior aspect of the pubic tubercle. Blunt dissection was carried down to bone, and a guidewire was advanced under fluoroscopic guidance along the intramedullary canal of the superior pubic ramus, traversing the fracture site. The 7.5mm CurvaFix medullary device was then inserted over the guidewire, conforming to the osseous curvature and achieving stable fixation across the fracture. The procedure was repeated for the contralateral side. For sacral fixation, percutaneous iliosacral screws were placed under fluoroscopic guidance through small lateral incisions over the posterior ilium.

The use of the CurvaFix medullary device allowed for anatomic alignment and stable fixation of the bilateral pubic ramus fractures by accommodating the natural curvature of the osseous pathway, which is often challenging with traditional straight implants. This technique provided robust fixation in a fracture pattern that is historically difficult to stabilize, minimizing soft tissue disruption and facilitating early mobilization.

Postoperative protocol:   The postoperative rehabilitation protocol included immediate non-weight bearing mobilization with a walker for 6 weeks, followed by progressive weight bearing as tolerated. Range of motion exercises for the hip and knee were initiated on postoperative day one.

Follow up:   Not specified

Orthopaedic implants used:   7.5mm CurvaFix Medullary Device (bilateral). Cannulated iliosacral screws.