Sequence of the treatment
The sequence of reduction of the typical associated both column fracture reduced via the
extended iliofemoral approach begins with the reconstruction of the ilium.
Reduction of the SI joint dislocation component when applicable (1-2)
Iliac crest (3) to reconstructed intact ilium (1-2)
Anterior column (4) to reconstructed ilium (1-2-3)
Posterior column (5) to retroacetabular surface (2)
The reduction sequence will vary depending on the fracture morphology to some extent. For example, if there is a posterior wall component, it may require reduction prior to the reduction of the posterior column (5).
Additionally, there may be cases in which the posterior column reconstruction to the intact ilium precedes the anterior column reduction.
The associated both column fractures operated by the extended iliofemoral approach are the most complex and difficult fracture patterns. Though the sequence may vary from case to case, it is critical to have a well thought out surgical strategy prior to surgery.