Surgical Discussion

Patient positioning:  The patient was initially positioned supine for the anterior approach.

Anatomical surgical approach:  The ilioinguinal approach was employed, beginning with exposure of the iliac wing via the lateral window. The anterior column was accessed and manipulated through the middle window or Stoppa approach, allowing for reduction and fixation without interference with posterior elements.

Following the anterior approach, intraoperative reassessment with anesthesia was conducted to evaluate blood loss, resuscitation status, and operative time. Upon satisfactory assessment, the patient was repositioned prone for a posterior approach using the Kocher-Langenbeck technique. The Jungbluth and goose-neck retractors facilitated exposure of the segmental posterior column and wall. The posterior wall was buttressed, and a second plate was applied to reinforce the posterior column.

Postoperative protocol:   Postoperatively, a rehabilitation protocol was initiated with non-weight bearing on the affected side for 6 weeks, followed by gradual weight-bearing as tolerated. Range of motion exercises were encouraged early to prevent joint stiffness.

Follow up:   Not specified.

Orthopaedic implants used:   Anterior column plate, posterior column plate.