Case: A 47-year-old obese woman presented with a vertical shear (VS) pelvic ring injury after a motor vehicle accident around her previous posterior pelvic hardware. The patient underwent closed reduction with percutaneous posterior screw fixation using combined fluoroscopy and O-arm (Medtronic).
Conclusion: A rare case of VS pelvic injury with indwelling posterior pelvic hardware does not automatically preclude placement of percutaneous sacroiliac and transiliac-transsacral screws. Combining fluoroscopic imaging and O-arm enables safe screw placement, saving patients from invasive surgeries.