Staged management of a Tile C3 pelvic ring injury with bilateral sacroiliac disruption and T-shaped sacral fracture.

We present the case of a 16-year-old female polytrauma patient who sustained a rare and highly unstable pelvic ring injury following a high-energy motor vehicle collision with partial ejection. The injury pattern was classified as Tile C3, combining a right anterior crescent-type fracture with anterior sacroiliac (SI) joint dislocation, a left-sided Denis II sacral fracture, a distal T-shaped sacral fracture, and bilateral pubic rami fractures. Neurological deficits included right L5 and left S1-S2 involvement. Initial management adhered to damage control principles, including pelvic binder application, preperitoneal packing, and temporary external fixation. Due to cranial migration of the right hemipelvis and neurovascular compression, urgent anterior open reduction and SI joint plating were performed via an ilioinguinal approach. Definitive fixation, performed on day five, included percutaneous dual iliosacral screws for the Denis II fracture and bilateral retrograde pubic ramus screws, while the distal T-shaped sacral fracture was treated conservatively. The patient achieved stable fixation without implant failure, enabling early mobilization. At 12 months, radiographs demonstrated consolidation of the pelvic ring injuries with maintained alignment and no implant failure. She walked independently with an ankle-foot orthosis for persistent right foot drop, although residual L5-S1 motor weakness and altered reflexes persisted. Functional scores demonstrated marked recovery (Majeed 70/80; Iowa 85/100). This case highlights the importance of individualized, staged surgical strategies in managing complex pelvic fractures with combined rotational and vertical instability, especially in the presence of neurological injury and visceral trauma.