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|
|Pubic symphysis disruption with type B or C pelvis instability|
- 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)
- Patient not fit for open surgery
- Minor symphysis widening, which does not increase with stress x-ray
- Open injury with significant contamination
- Stable fixation (protects posterior repair)
- Helps reduce posterior pelvic arch fracture
- Earlier mobilization
- Fairly frequent hardware loosening (typically asymptomatic, without need to remove
- Hardware removal may be necessary (tenderness, prominence, before pregnancy)
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|