Executive Editor: Peter Trafton

Authors: Rahul Banerjee, Peter Brink, Matej Cimerman, Tim Pohlemann, Matevz Tomazevic

Pelvic ring - Pubic symphysis

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Glossary

General considerations

Before proceeding with definitive repairs, the patient must be fully resuscitated, fully evaluated, and fit for anesthesia and surgery by a prepared team.

Pubic symphysis disruption usually results from high energy trauma that produces external rotation (open book) deformity, or vertical shear.

If the disrupted symphysis is associated with a rotationally unstable pelvic injury (type B), its repair will both reduce and stabilize the posterior injury. If the pelvic ring injury is totally unstable (type C), repair of the symphysis will contribute to reduction of the posterior injury but posterior fixation will also be required.

Pubic symphysis plate
Main indication Skill Equipment
Pubic symphysis disruption with type B or C pelvis instability Highly experienced and skilled surgeon Simple surgical and imaging resources

Indications

  • Pubic symphysis disruption with type B or C pelvis instability
  • As a part of combined anterior and posterior repair to restore stability
  • As first stage of a combined repair, to facilitate reduction of the posterior disruption
  • As part of repair for locked symphysis or tilt fracture (B2 injuries)

Contraindications

  • Patient not fit for open surgery
  • Minor symphysis widening, which does not increase with stress x-ray

Relative contraindications

  • Open injury with significant contamination

Advantages

  • Stable fixation (protects posterior repair)
  • Helps reduce posterior pelvic arch fracture
  • Earlier mobilization

Disadvantages

  • Fairly frequent hardware loosening (typically asymptomatic, without need to remove
  • Hardware removal may be necessary (tenderness, prominence, before pregnancy)
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

2016-10-20