Surgical Discussion

Patient positioning:  Supine with a bump under right hip

Anatomical surgical approach:  1)Pfannensteil approach to reduce and fix symphysis,2)Lateral window approach to reduce and fix iliac wing.

Operative remarks: 

The symphysis reduction was achieved with traction,adduction,internal rotation of both lower limbs and by direct manual pressure of both greater trochanters.

Reduction was secured with a pointed reduction clamp and provisionally fixed with a kwire across symphysis.

6 holed pubic symphysis specific plate was placed and secured with k-wires.

Iliac wing fracture was exposed through lateral window approach.

Reduction was achieved indirectly during reduction of symphysis with some residual displacement which was reduced with a ball spike pusher and provisionally fixed with k-wires.

Definitive fixation of iliac wing fracture was achieved by interfragementary screws and a 6 holed curved pelvic recon plate.

Symphysis plate is fixed with 3 screws on left side and 2 screws on right as the last plate hole on right was off anteriorly.

Fixation strength was checked by stressing under continuous flouroscopy and found to be stable.

Wounds were closed with a drain after thorough saline lavage.

Postoperative protocol:   Post op was uneventful. Patient was made to sit immediate post op day 1 passive hip ROM and active knee and ankle ROM started. Weight bearing restriction for 6 weeks Ambulated with walker after 6 weeks-weaning of until 3 months post op

Follow up:   At 6 months follow up Wound healthy Full hip ROM Walking without any difficulty No restriction on daily activities No sexual dysfunction reported Patient was lost to follow up after that

Orthopaedic implants used:   6 holed symphysis plate 6 holed curved recon plate Interfragmentary cortical screws.