Staged Reduction and Combined Anterior and Posterior Minimally Invasive Fixation for a Highly Unstable Open-Book Pelvic Ring Fracture: A Case Report

Vertically and rotationally unstable pelvic fractures are challenging to treat because they require accurate reduction and stable fixation, while conventional open procedures are associated with substantial morbidity.We report a highly unstable open-book pelvic ring fracture with marked displacement that was successfully treated using a staged reduction strategy and combined anterior and posterior minimally invasive fixation.A 27-year-old man presented with an open-book pelvic ring fracture.Computed tomography confirmed pubic symphysis reduction after external fixation; however, widening of the posterior aspect of the left-sided sacral fracture had become apparent, suggesting complete rupture of the posterior sacroiliac ligament.The sacral fracture was reduced and provisionally fixed while preserving rotational mobility of the left ilium.Pubic symphysis diastasis was reduced using anterior subcutaneous internal fixation in the supine position, followed by definitive posterior fixation in the prone position.A staged reduction strategy and combined anterior and posterior minimally invasive fixation achieved satisfactory reduction and favorable functional recovery, which was maintained at three years postoperatively.