Surgical management of concomitant and delayed complex pelvic and acetabular fractures

Managing pelvic ring and acetabular fractures at a late stage of malunion or nonunion is a therapeutic challenge due to the complexity of both the surgical technique and strategy. We report the case of a 42-year-old male patient with pelvic and left hip trauma diagnosed 40 days postinjury, after a prolonged intensive care stay for severe chest trauma. Imaging revealed a Tile-AO B1-2 pelvic fracture with associated transverse-posterior wall acetabular fracture and femoral head dislocation. A two-stage surgery using multiple approaches was performed to remove callus and achieve reduction and fixation. The initial outcome was favorable. At 10 months, the patient developed left hip osteoarthritis and underwent primary total hip arthroplasty. At 36-month follow-up, he had a Harris Hip Score of 85, a Majeed score of 86, and had resumed near-normal daily activities. These complex cases require careful planning, with early surgical reduction being essential in displaced recent fractures.