Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent table to facilitate access to the hemipelvis and allow for intraoperative imaging.

Anatomical surgical approach:  A direct lateral approach to the os ilium was performed, with incision centered over the iliac crest. Subperiosteal dissection was carried down to expose the fractured segments of the ala ossis ilii. The open wound was incorporated into the exposure for thorough irrigation and debridement. Fracture fragments were anatomically reduced and stabilized with interfragmentary lag screws placed between the inner and outer tables of the ilium.

The comminuted nature of the fracture required careful sequential reduction of multiple small fragments. Given the open nature of the injury and risk of contamination, meticulous irrigation and debridement were performed both through the traumatic wound and via surgical exposure. Lag screw fixation was selected to minimize hardware prominence and reduce surface area for potential infection. The traumatic wound was closed primarily with sutures due to satisfactory soft tissue condition; surgical incisions were closed in layers over drains.

Postoperative protocol:   Early mobilization with protected weight bearing as tolerated was initiated postoperatively. Hip range of motion exercises were commenced immediately, with progression to full weight bearing as radiographic healing permitted.

Follow up:   Not specified

Orthopaedic implants used:   4.5mm cortical lag screws, 3.5mm cortical lag screws