I will repair the pelvic fracture and reduce the Hip and will expect the foot drop due to neuropraxia to resolve to some extent

I think, in younger age, We should try to fix the fracture. So, my suggestion is to do extended ilioinguinal approach and reduce the symphysiolisis and anterior coloumn acetabular fracture with long reconstruction plate and then turn to posterior approach to do open reduction of dislocated hip and fixation for posterior coloumn. in younger age, chance fot nerve regeneration also high.

We did post. and ant.fixation in the same sitting. post fixation was very difficult due to scarring.

Dear Raju

I can see that already the hip was fixed and this is great. Personally I will not consider a total hip replacement to start with and I can see that this is not done. The reason is very simple; there is no stability at the acetabulum and a cage will fail. Patient I am sure that is informed for the risks of a secondary post traumatic arthritis and possible replacement at a second stage. It is a great work to a very demanding patient. Thank you for sharing. 

I appreciate the way Mr Raju did fixed the pelvis without going for THR. This lady will do well regarding Nerve palsy . We get enough time to reduce her body weight by Bariatric surgery and then when situation prevails to do the Hip replacement

Dear Raju, Very difficult case, specially acetabulum with  comminuted  fracture and very good post op result. Gongratulation!

Thanks George, Amal and Cen. of course, the need for THR has been explained and the doubtful recovery of neurology 

the repair can be done by modifying the posterior approach going between gluteus and Rectus femoris

The best pain management for this patient is epidural nerve block

Restore the laodbearing structures of pelvis.

http://scholar.google.de/scholar_url?url=http://sites.google.com/site/vallejojames/anatomiaybiomecanica.pdf&hl=de&sa=X&scisig=AAGBfm3CJCCRSbaICaaTpITXUBRS4FukTg&nossl=1&oi=scholarr&ved=0ahUKEwiei_aP-fDQAhVhOMAKHU17AYwQgAMIICgAMAA

The patient should have physiotherapy on bed ,remain non weight bearing for minimum of 6 wks, then slowly mobilizing with a flexible Foot drop splint attached and on a walker loading 1/10 of her body wt. with gradual increment by 10lbs every week.Hip abduction,Gluteal muscles strengthening exercises to be done followed by Hydrotherapy, till radio logically and clinically the of Pelvis shows union. The Hip Joint CT by MRI Scan every 3-6 months to see evidence of AVN developing. When seen Core Decompression and vascularised Fibular grafting could be the treatment of choice.

I will never go for primary THR

ORIF (with all possible technical difficulties but can turn to be beneficial for the foot drop on the ipsilateral side) and later (after several months ?)  when the pelvis heals (eventually) THR. The case is really very difficult.

I had my initial answer to this question befor but unfortunetly that was not saved. Anyway, I would suggest  ORIF of Pelvic fracture , with Titenium implants,reducing the Hip and start mobilising the Legs on Bed  with foot drop spints. After 6 wks of surgery she should be mobilished  wearing flexible Foot Drop spint and a walker.Watch the Rt Hip for evidence of AVN and recovery  of common peroneal nerve. NCV study of both lower limbs will suggest type of nerve injury and the site of lession MRI scan at this stage will show both the Rt Hip and Nerves