case_images: PMC6727463_01
case_images: (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.
case_images: JOCR-9-64-g002.jpg
case_images: PMC6727463_01_JOCR-9-64-g002.jpg
case_images: F1
case_images: 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).
case_images: Post-binder CT scan demonstrating a complete, midline sacral fracture through the anterior (solid arrow) and posterior (open arrow) cortices.
case_images: JOCR-9-64-g003.jpg
case_images: PMC6727463_01_JOCR-9-64-g003.jpg
case_images: F2
case_images: 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).
case_images: Intraoperative fluoroscopic image following open reduction and recon plating of the pubic symphysis with percutaneous transiliac screw fixation of the midline sacral fracture.
case_images: JOCR-9-64-g004.jpg
case_images: PMC6727463_01_JOCR-9-64-g004.jpg
case_images: F3
case_images: 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).
case_images: 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.
case_images: JOCR-9-64-g005.jpg
case_images: PMC6727463_01_JOCR-9-64-g005.jpg
case_images: F4
case_images: 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).