An antero posterior view of case 4 with right iliac wing fracture involving the SI joint at the inferior part. Bilateral superior pubic rami fractures. There is a subtle crack of the sacrum on the left side through the sacral foramina.

Inlet view showed the iliac wing fracture as well as the internal rotation displacement with widening of the lateral part of the iliac wing fracture.

On the outlet view there is some vertical displacement and the Dennis type II fracture of the left side of the sacrum can also be identified

On axial CT the fracture of the ilium involving the inferior part of the SI joint and one can see the fracture of the left side of the sacrum.

Comminution of the fracture involving the inferior part of the right SI joint.

Mild widening of the right SI joint area inferiorly.

The fracture on the left side of the sacrum inferiorly can be seen.

In the supine positin, anterior approach to the right SI joint allows open reduction and internal fixation of the iliac fracture, reduction and fixation of the SI joint with plating. A percutaneous fixation of the left sacral fracture is done. An iliac crest fixator is applied for further stability of the anterior ring failure. Nowadays pins are mostly applied to the anterior inferior iliac spines.

Inlet view reveals a satisfactory ring reconstruction with a left SI screw inserted into the sacral body.Note satisfactory reduction of the superior pubic ramus fracture.

Outlet view shows reduction of the vertical displacement and the position of the sacral screw above the S1 foramen.

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