Management of a complex pelvic fracture in a 43-year-old man

• 43-year-old male
• Climbing accident
• Polytrauma with among other things, a complex pelvic fracture

What are the functions of the pelvic binder?

• ✔️Diminution of the pelvic volume
• ✔️Stabilization of clots from bony surfaces and vascular structures

^{Bottlang M, Krieg JC, Mohr M, Simpson TS, Madey SM. Emergent management of pelvic ring fractures with use of circumferential compression. J Bone Joint Surg Am. 2002;84-A Suppl 2:43-7. doi: 10.2106/00004623-200200002-00005. PMID: 12479338.}

What type of fracture is it?

• ✔️Vertical shear according to Young and Burgess classification
• ✔️Associated both column fracture according to Judet and Letournel

^{Judet R, Judet J, Letournel E: Fractures of the acetabulum: Classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am 1964;46:1615-1646.
Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, Bathon GH, Brumback RJ. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990 Jul;30(7):848-56. PMID: 2381002.}

What are the main sequelae of this kind of trauma?

• ✔️Sexual dysfunction
• ✔️Chronic pain

^{Vallier HA, Cureton BA, Schubeck D: Pregnancy outcomes after pelvic ring injury. J Orthop Trauma 2012;26(5):302-307.
Metze M, Tiemann AH, Josten C: Male sexual dysfunction after pelvic fracture. J Trauma 2007;63(2):394-401}

Final strategy decision

• The posterior pelvic injury was first anatomically reduced and stabilized by two iliosacral screws.
• Then the anterior column of the acetabulum was reduced and stabilised by 2 anteroposterior iliac screws and one retrograde anterior column screw, the symphysis was plated.
• Finally, the posterior column was reduced through a Kocher-Langenbeck approach and fixed to the anterior column with a magic screw and a posterior plate.