Falls from height represent a significant mechanism of high-energy trauma with substantial morbidity and mortality. We present a 28-year-old male who sustained a suspected 6-story fall resulting in hemorrhagic shock and a mechanically connected acetabular and pelvic ring injury (MCAPI). MCAPIs are a rare injury pattern that only occurs in 3-15.7% of all patients with pelvic or acetabular fractures. Management typically involves a single operation of pelvic ring fixation followed by acetabular fixation. This case presents a unique challenge of an AbThera wound vac obstructing surgical access for acetabular fixation, which lacks guidelines in the literature. The patient presented a positive FAST exam, prompting emergent laparotomy, which revealed multiple hepatic lacerations and mesenteric injuries requiring hemorrhage control. Given hemodynamic instability, a massive transfusion was required. Due to planned re-exploration, an AbThera wound vac was placed following laparotomy. Imaging revealed extensive injuries consistent with a diagnosis of polytrauma, including bilateral acetabular fractures, sacral wing fracture, and bilateral SI joint widening. Following early appropriate care guidelines, approximately 36 hours of post-injury, posterior pelvic ring stabilization was performed while the AbThera remained in place. However, bilateral acetabular fixation could not be completed due to inaccessibility from the AbThera. Following abdominal closure 48 hours later, definitive acetabular fixation was performed, achieving anatomic reduction. On hospital day 14, the patient was discharged to home health with wheelchair mobility, tolerating brief weight bearing, and follow-up imaging suggested maintained anatomical reduction. At one-year follow-up, the patient has returned to pre-injury status with a primary complication of pain and gluteal weakness. This case highlights a unique staged approach of pelvic ring and acetabular fixation necessitated by surgical inaccessibility due to AbThera placement, leading to anatomic reduction and no postoperative infection.
