Article viewed 54 times

19 Jul 2025
Add to Bookmarks


 

When One Plate Isn’t Enough: Pelvic Fixation Strategy in a 437lb Bull-Rider

Score and Comment on this Case

Select a Score out of 10, and add a comment in the field below

Respectfully consider international variabilty in surgical technique and implants when commenting.
Protected by reCAPTCHA - Privacy and Terms


Clinical Details

Clinical and radiological findings:  A 44-year-old male, weighing 437 lbs and standing 5'7", sustained a pelvic ring injury following a mechanical bull ride accident. The patient is classified as super obese, presenting unique challenges in the management of pelvic trauma. Initial radiographs confirmed a pelvic ring disruption. The patient's obesity necessitated a tailored approach to fixation strategy.

Preoperative Plan

Planning remarks:  The preoperative plan involved a dual fixation strategy, employing both anterior and posterior stabilization techniques. An anterior approach was planned for plating, while posterior fixation was to be achieved with multiple sacroiliac screws. The use of a Jungbleuth clamp was planned for reduction due to its power and multiplanar control capabilities.

Surgical Discussion

Patient positioning:  Supine positioning on a radiolucent table was utilized to facilitate anterior and posterior access for fixation.

Anatomical surgical approach:  An anterior approach to the pelvis was performed via a Pfannenstiel incision, allowing access for plate fixation. Posteriorly, percutaneous placement of multiple sacroiliac screws was executed under fluoroscopic guidance.

Operative remarks: 

The surgeon emphasized the importance of "belt and suspenders" fixation in super obese patients to prevent failure of fixation. The decision to employ double fixation was made to avoid potential revision surgeries. An incisional wound vacuum-assisted closure (VAC) with layers of Ioban was applied and maintained until discharge.

Postoperative protocol:   Postoperative rehabilitation included extended weight-bearing restrictions, with non-weight bearing status maintained for an extended period, consistent with protocols for diabetic ankle fractures.

Follow up:   Not specified

Orthopaedic implants used:   Anterior pelvic plate, multiple sacroiliac screws, incisional wound VAC with Ioban layers.

Search for Related Literature

Powered by OrthoSearch - The British Editorial Society of Bone & Joint Surgery


#

orthopaedic_trauma
  • United States , Seattle
  • Area of Specialty - General Trauma
  • Position - Specialist Consultant
#
Industry Sponsership

contact us for advertising opportunities


Peer Review Score

Average Score based on 0 reviews

Catalogue Index