An 18 years old male following an RTA with a resultant fracture dislocation of right SI joint but with no anterior ring injury. Patient is shocked, with an open wound extending across the girth of the abdomen from the left anterior inferior iliac spine to the right iliac crest. There is a right femoral nerve injury.

Axial CT scan of the right SI joint reveals the open right SI joint and a part of the iliac wing fracture. Note that the anterior abdominal wall is disrupted.

Significant widening of the SI joint is clear with starting the upper part of the greater sciatic buttress bone.

The fracture involves the inferior part of the right SI joint with an apparent part of the greater sciatic notch buttress appearing wedged into the joint. this needed to be delivered out of the joint to allow closure of the SI joint.

As an emergency procedure due to failure of active resuscitation, patient was operated upon through the same traumatic wound which is similar to an extended long ilioinguinal incision (note the surgical clips extending to the contralateral side of the fracture). Once the SI joint was fixed, haemorrhage was controlled. Debridement was concluded. Rest of the iliac wing was fixed. Femoral nerve was tagged for later neurosurgical repair.

Follow up after 3 months with full weight bearing. Patient had repair procedure of the femoral nerve by microvascular surgeon in our institute.

Close up view of the SI joint after healing on 3 months follow up.

If you feel like posting comments, enquiries or questions please click here.