Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent table to allow for intraoperative fluoroscopic imaging and access to both anterior and posterior aspects of the pelvis.

Anatomical surgical approach:  A posterior approach was initially planned for the APC2 side, but screw reduction was achieved percutaneously due to intact posterior ligaments. An anterior approach was utilized for the symphysis pubis and ramus fractures, involving an open reduction and internal fixation with plating. The APC3 side was managed with a combination of open anterior reduction and percutaneous posterior screw fixation.

The surgeon noted that achieving a stable hemi-pelvis on the APC2 side facilitated subsequent reduction maneuvers on the APC3 side. The decision to avoid opening the posterior aspect of the APC3 side was based on achieving satisfactory reduction of the anterior elements first. An antegrade wire was used for ramus screw placement, delaying final screw insertion until posterior stabilization was complete to ensure optimal alignment.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing (NWB) status for 6 weeks, progressing to partial weight bearing (PWB) as tolerated from week 7, with full weight bearing (FWB) anticipated by 12 weeks post-surgery.

Follow up:   Not specified.

Orthopaedic implants used:   Percutaneous SI screws, anterior symphyseal plate, antegrade wire for ramus screw placement, mega screw for posterior stabilization.