Surgical Discussion

Patient positioning:  The patient was positioned supine for the initial stage of pelvic ring stabilization.

Anatomical surgical approach:  For the pelvic ring stabilization, a posterior approach was employed to access the left sacroiliac joint and sacral fracture. In the second stage, a Kocher-Langenbeck approach was planned for acetabular ORIF, with potential anterior column access through a modified Stoppa approach.

The surgical team emphasized the importance of achieving an anatomical reduction of the acetabulum while ensuring stable fixation of the pelvic ring. The presence of the suprapubic catheter necessitated careful planning to avoid interference with surgical access and fixation. The decision to prioritize pelvic ring stabilization first was based on providing a stable segment for accurate acetabular reconstruction. Intraoperative challenges included ensuring precise screw trajectory for sacral fracture fixation and managing potential displacement during reduction maneuvers.

Postoperative protocol:   Postoperative rehabilitation included initial non-weight bearing on the affected side, with gradual progression to partial weight bearing as tolerated. Range of motion exercises were initiated early to prevent joint stiffness, with emphasis on avoiding stress on the surgical repairs.

Follow up:   Not specified

Orthopaedic implants used:   Lag screws for sacroiliac joint and sacral fracture fixation, external fixator for posterior ring stabilization, potential plate and screw constructs for acetabular ORIF through Kocher-Langenbeck and modified Stoppa approaches.