Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent table, with a bump under the ipsilateral flank to elevate the hemipelvis and facilitate lateral access to the iliac wing.

Anatomical surgical approach:  A longitudinal incision was made over the iliac crest, extending from the anterior superior iliac spine (ASIS) posteriorly along the crest. Subperiosteal dissection exposed both the outer and inner tables of the os ilium. The exposure was extended medially to include the lateral half of the inguinal portion of an ilioinguinal approach, providing broad visualization of the fossa iliaca interna for fracture debridement, manipulation, reduction, and application of clamps. Careful preservation of the origins of musculus gluteus medius and minimus laterally, and musculus iliacus medially, was maintained.

The comminuted fragments were mobilized and reduced using pointed reduction forceps and ball-spike pushers under direct vision. Lag screws were placed transversely between the inner and outer cortical tables of the ilium to achieve interfragmentary compression across major fracture lines. A pre-contoured reconstruction plate was then applied along the crest and tensioned to supplement the lag screws, providing additional stability across zones of comminution. The expanded exposure facilitated thorough cleaning of hematoma and debris, precise reduction, and secure clamp placement during fixation.

Postoperative protocol:   Postoperatively, toe-touch weight bearing with crutches was instituted for 8 weeks. Active-assisted range of motion exercises for hip and knee were commenced immediately. Progressive weight bearing was planned from week 9 onwards, contingent on radiographic evidence of healing.

Follow up:   Not specified

Orthopaedic implants used:   3.5mm cortical lag screws; pre-contoured 3.5mm reconstruction plate