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Posterior column: reduction

Multiple reduction adjuncts will be required to successfully reduce the posterior column (5). Furthermore, lateral traction is critical at this stage to allow manipulating of the posterior column around the femoral head.

In this case, a two-screw reduction technique manipulating the posterior column (5) to the reconstructed ilium and anterior column (1-4) is accomplished using a Farabeuf clamp. Another possibility is to use a pointed reduction forceps across the fracture, or a Jungbluth clamp.

A bone hook has been applied through the notch to adjust the rotational reduction. While the hook applies the force from medial to lateral, the clamp will close the fracture line and derotate the posterior column fragment. Take great care not to damage the sciatic nerve. A Schanz screw in the ischial tuberosity is also useful as a joystick.