Total laparoscopic closed reduction and internal fixation for AO/OTA B2.1 pelvic fracture: A case report and literature review

Endoscopic techniques have been widely used in orthopedic surgery, such as arthroscopy and transforaminal endoscopy, but the application in fracture is rarely reported. We reported a case of a 69-year-old male with pelvic fracture (AO/OTA type B2.1) who underwent successful laparoscopy-assisted pubic ramus plate fixation without auxiliary incision. We designed and applied a separate custom-made lengthening surgical instrument for internal fixation installation suitable for laparoscopic surgery, and the entire reduction and internal fixation installation were performed under laparoscopy. The patient could sit up 1 day after surgery, and the reported pain visual analogue scale score decreased from 5 points before surgery to 1 point. At 2 weeks after surgery, the patient could walk with a single crutch. At 4 weeks after surgery, the Majeed score was 73 points, and at 10 weeks after surgery, the Majeed score increased to 81 points. Twelve weeks after surgery, the patient was able to walk independently without pain, with normal defecation and urination function, and the Majeed score was 87. Laparoscopic surgery is a new strategy for treating pelvic ring fractures. The case proves that full laparoscopic-assisted closed reduction and internal fixation of pelvic fractures is feasible.