Abstract
Unstable pelvic ring injuries continue to be challenging to manage. Obese patients have a higher risk of complications and such management entails additional difficulties for emergency services and the medical-surgical team. A 41-year-old male with a body mass index of 44 fell from a water slide and suffered an anteroposterior pelvic compression impact injury. He presented with a Tile C1.3 pelvic fracture, Denis III sacral fracture, and Roy-Camille Type 4 spinopelvic dissociation. We performed a posterior triangular fixation and anterior double plating, and the patient gained full recovery and was able to return to work. This case report focuses on some key tools and techniques to consider when managing complex pelvic fractures in obese patients, requiring specialized equipment or adjustments to conventional treatments to obtain a good outcome. We used accessory portals through the fat pad to adequately place the plate screws. In addition, we used polypropylene mesh for post-operative incisional hernia prophylaxis, longer instruments for iliosacral screw placement, and a multidisciplinary approach with rehabilitation and nutrition control.