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05 Aug 2025
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APC II Pelvic Ring Injury with Sagittal and External Rotation Deformity.

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Clinical Details

Clinical and radiological findings:  A 44-year-old male presented to the emergency department following a snowmobile accident involving a 6-foot drop. Initial radiographs revealed an anterior-posterior compression (APC) type II pelvic ring injury, characterized by instability in two planes: sagittal plane rotational deformity with extension of the right hemipelvis, and external rotation deformity. The sacroiliac (SI) joint was noted to be displaced.

Preoperative Plan

Planning remarks:  The preoperative plan involved closed reduction of the symphysis pubis with careful attention to the alignment of the SI joint. If the SI joint remained displaced after symphyseal reduction, an open reduction through a lateral window approach was considered prior to final fixation of the symphysis.

Surgical Discussion

Patient positioning:  Supine position on a radiolucent table to facilitate intraoperative imaging and manipulation of the pelvic ring.

Anatomical surgical approach:  A Pfannenstiel incision was utilized for access to the symphysis pubis. In cases requiring SI joint intervention, a lateral window approach to the SI joint was prepared, involving dissection through the gluteal musculature to expose the joint for potential open reduction.

Operative remarks: 

The symphyseal reduction achieved accurate realignment of the SI joint, negating the need for additional open reduction through the lateral window. The importance of recognizing and addressing both sagittal and external rotation deformities was emphasized to ensure stable fixation and optimal postoperative outcomes.

Postoperative protocol:   Postoperative rehabilitation included protected weight-bearing with crutches for 6 weeks, followed by gradual progression to full weight-bearing as tolerated. Emphasis was placed on early mobilization and strengthening exercises to restore function.

Follow up:   Not specified.

Orthopaedic implants used:   Symphyseal plate fixation system.

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