The ‘nightstick’ ischial fracture: a unique oddity of the pelvic injury family

Abstract

We present an unusual ischial fracture unreported in the literature. We discuss the mechanism and describe the appropriate investigations and surgical management of this fracture. A 36-year-old man sustained a direct blow to his right buttock following a fall from a dirt bike. Examination revealed a firm haematoma, with severe pain on any stretch involving the posterior compartment of the thigh. Radiographs revealed a displaced fracture of the ischial body. CT confirmed integrity of the pelvic ring. The patient underwent open reduction and internal fixation with a partially threaded cannulated screw via a ‘modified longitudinal’ posterior approach to the ischium. The patient was managed partially weight-bearing for 6 weeks; 6-month follow-up confirmed satisfactory clinical and radiographic outcomes. Clinicians should be aware of this novel pelvic fracture and its unusual presentation, currently not included in any pelvic fracture classification system. We report a novel operative technique for appropriate surgical management of such injuries.