Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent table to facilitate both anterior and lateral access to the pelvis.

Anatomical surgical approach:  A direct lateral approach to the iliac wing was performed, with incision along the crista iliaca, subperiosteal elevation of musculature, and exposure of the SI joint for reduction and fixation. Anterior external fixator pins were inserted percutaneously into the supra-acetabular region under fluoroscopic guidance.

The case demonstrates a significant complication associated with combined use of internal fixation and anterior pelvic external fixation, specifically when pin tracts are placed in proximity to or in communication with deep surgical wounds. In this instance, direct contamination of the deep iliac wound by superficial pin tract infection resulted in a deep abscess, as evidenced by identical purulent material at both sites and radiological continuity on CT imaging. This highlights the risk of iatrogenic deep infection and potential hip sepsis when low external fixator pins are used in conjunction with open pelvic approaches. Alternative stabilization techniques should be considered to avoid this complication.

Postoperative protocol:   Postoperative rehabilitation was not specified due to infectious complications requiring further intervention.

Follow up:   Not specified

Orthopaedic implants used:   Pelvic reconstruction plate(s), cannulated SI screw(s), anterior external fixator (supra-acetabular pins).