Case: An 18-year-old adolescent sustained a lateral compression injury to the pelvis that featured a locked pubic symphysis with plastic deformation of the sacrum. The pubic bone was entrapped in the opposite obturator foramen and required a novel distraction osteotomy of the superior ramus to restore the symphysis. The patient developed a urethral stricture 3 months after injury that required urethroplasty. The symphysis remained in alignment without any morbidity at the osteotomy site over 13 months of follow-up. Conclusion: Locked pubic symphysis is frequently associated with urethral injuries. The distraction osteotomy of the superior pubic ramus described is a viable reduction maneuver that neutralizes the plastic deformation forces.

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