PMC7530218_01
Pelvic anteroposterior X-rays taken before surgery.
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Emergency pelvic radiographs (Fig. 1) and computed tomography revealed a lateral compression fracture with internal rotational instability; fracture of the left sacral wing (Denis grade 1) was associated with bilateral fracture of the obturator bone frames (grade AO/OTA 61B2.1b).
Laparoscopic views of the transperitoneal approach. Opening of the Retzius space using bipolar forceps and monopolar scissors (AB) allowing to reach pelvis (C), and see the right anterior arch (solid arrows), the fracture of the right obturator frame (hatched arrows), and the hematoma (*).
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Two further 10/12-mm trocars were added, triangulating the left and right pararectal areas. The Retzius space was opened using bipolar forceps and monopolar scissors (Fig. 2A). Dissection proceeded to the endopelvic fascia covering the base of the prostate (Fig. 2B-C).
Laparoscopic views obtained after the pubic arch dissection (A), during the positioning of the plate using forceps (B) and the ball-spike pusher (C), and after screws insertion (D).
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After dissection was adequate (Fig. 3A), a 10-hole, Matta curved plate (Stryker GmbH, Selzach, Switzerland) was inserted through a trocar and retrieved using forceps (Fig. 3B). When the plate was appropriately positioned on the anterior arch of the pelvic ring, it was fastened using a ball-spike pusher inserted into a trocar (Fig. 3C). All screws required for reliable fixation were successfully inserted (Fig. 3D).
Pelvic anteroposterior X-rays taken after surgery.
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We encountered no intraoperative complications; the patient did not react negatively to laparoscopy; and the postoperative X-rays were satisfactory (Fig. 4).