Staged management of a compound combined pelvi-acetabular injury with perineal degloving in a young female: a case report and literature review

We present the case of a 30-year-old woman, the patient who sustained a compound combined pelvi-acetabular fracture with extensive perineal internal degloving after high-energy trauma. Computed tomography revealed an unstable pelvic ring injury (Tile type C1; anteroposterior compression type III) with right transverse acetabular fracture. The occurrence of extensive internal degloving was confirmed intraoperatively. The injury was treated using a graduated, principle-based approach incorporating early soft-tissue debridement, dead-space management and temporary pelvic stabilization, infection control, and delayed definitive internal fixation. An intercurrent pin-site infection was treated successfully without progression to deep infection. The patient demonstrated progressive radiological union at 4 months with a Harris Hip Score (HHS) of 80 and a Majeed pelvic score of 55. At one-year follow-up, complete union occurred and functional recovery was achieved, characterized by HHS of 90 and a Majeed score of 70. In this case, infection-guided staging as well as extremely aggressive soft tissue treatment may allow for safe delayed fixation even where pelvi-acetabular trauma has been compromised.