PMC6727463_01
(a) Initial radiograph demonstrating 4.7 cm of pubic symphysis diastasis (open arrows) with a midline sagittal sacral fracture (solid arrows) and intact sacroiliac joints. (b) Post-binder application with reduction of the pubic diastasis. The sacral fracture is no longer clearly evident.
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F1
Anteroposterior pelvic radiograph revealed pubic diastasis of 4.7 cm and a midline fracture through the sacral body with 1.0 cm of displacement (Fig. 1a). A pelvic binder was placed to decrease intrapelvic hemorrhage and repeat plain films demonstrated acceptable closure of his pelvic diastasis (Fig. 1b).
Post-binder CT scan demonstrating a complete, midline sacral fracture through the anterior (solid arrow) and posterior (open arrow) cortices.
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F2
After binder application and the placement of two large-bore intravenous cannulas administering crystalloid isotonic solution, hemodynamic stability was achieved and the patient was deemed stable a contrast-enhanced computed tomography CT scan revealed hemoperitoneum, 1.3 cm of pubic diastasis, and a complete, midline sacral fracture through the spinal canal and posterior sacral elements extending from S1 to the coccyx (Fig. 2).
Intraoperative fluoroscopic image following open reduction and recon plating of the pubic symphysis with percutaneous transiliac screw fixation of the midline sacral fracture.
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F3
Great care was taken to monitor the patient's skin condition beneath the binder to assure he did not experience any areas of skin necrosis or compromise. 2 days after hospital admission, he underwent open reduction internal fixation of the pubic diastasis using a pelvic reduction clamp and a 6-hole non-locking symphyseal plate by Pfannenstiel approach (Fig. 3).
Anteroposterior (a), outlet (b), and inlet (c) views of the pelvis at 5 months showing mild loss of reduction of the pubic symphysis and union of the midline sacral fracture. There are no radiographic signs of vertical or rotational instability.
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F4
Sacral fracture union was evident at 5 months with only mild loss of reduction at the pubic symphysis (1.3 cm of diastasis) (Fig. 4).