Bilateral displaced acetabular fractures associated with an open book injury of pelvis and sacral fracture

Abstract

Correspondence: Dr. Ravi Kumar Gupta, Associate Professor, Department of Orthopaedics, Government Medical College Hospital, Sector 32 B, Chandigarh – 160031, India. E-mail: ravikgupta2000@yahoo.com transfusion, urinary catheter, a pelvic binder and bilateral skeletal traction through proximal tibial Steinman’s pins. The CT scan of the head was unremarkable. There was no injury to the trunk. There was no clinical evidence of any neurological or vascular injury. X-ray pelvis (Figure 1) showed left-sided sacral fracture, pubic diastasis and bilateral acetabular fracture. A CT scan with 3D reconstruction showed the fracture of the sacrum on left side, T-shaped fracture of left acetabulum, grade 3 pubic diastasis and anterior column fracture of right acetabulum (Figures 2A–C). The fracture in the sacrum was a compression type of fracture as seen after a lateral compression force (Figure 2A). Since the patient was hemodynamically stable at the time of admission in our hospital, we directly planned for definitive fixation of fractures, rather than giving any temporary external fixation. The patient was operated with 2-stage surgery. The first surgery was performed by using a combined posterior and anterior surgical approach to stabilize the left acetabular fracture, and an anterior Pfanstiel approach for the pubic diastasis. The left acetabular fracture was first approached through the posterior approach with patient in lateral decubitus position. The fracture was fixed with a 10-holed 3.5 mm reconstruction plate. After closure of the wound, the patient was taken up in the supine position and the anterior segment of ‘T’ fracture was approached with an ilioinguinal approach which was fixed with 12-holed plate. Continuing the ilioinguinal incision as the Pfanstiel incision medially, the pubic diastasis was fixed with a 4-holed 3.5 mm reconstruction plate with the lateral most hole on the left side overlapping with the medial most hole of the anterior acetabular plate. The second stage of the surgery was performed after 7 days of the first surgery. The acetabular fracture was fixed with anteriorly applied 10-holed 3.5 mm reconstruction plate through the ilioinguinal approach. As a prophylaxis against ectopic ossification, the patient was administered 75 mg indomethacin daily for 6 weeks. Due to bilateral injury, the patient was allowed mobilization in the bed only for 12 weeks. Subsequently, patient was Bilateral displaced acetabular fractures associated with an open book injury of pelvis and sacral fracture