A novel press-fit minimally-invasive symphysiodesis technique

Abstract

Objective Instability of the pubic symphysis often results in a poor outcome and reduced mobility of the patient. In some cases, an arthrodesis of the pubic symphysis is required. Until today, there is no data published how many of these procedures are performed annually and there is also no data about the outcome after this extensive surgery. Methods We developed a novel surgical technique to address the arthrodesis of the pubic symphysis in a minimally invasive approach. Therefore, we used for this purpose modified instruments and performed the transplantation of a cylindrical bone substitute into the pubic symphysis, without an extensive approach or dissecting the anterior or posterior symphyseal ligaments. Results Using this novel technique, a minimally invasive symphysiodesis was achieved in radiological findings, after the procedure. Conclusion Thus, this actually minimally invasive surgical technique seems to be a promising advancement for the arthrodesis of the pubic symphysis.

A novel minimally invasive and press‐fit method for symphysiodesis — a biomechanical analysis

“…When conservative treatment fails, the arthrodesis of the pubic symphysis (symphysiodesis) is considered to be the gold standard to achieve adequate stability and pain relief [1,8]. According to the literature [6,9], a tricortical bone block from the iliac crest of the synthetic pelvis served as control group in the present study. A cylindrical graft, which in a clinical setup could be harvested from the proximal tibia, as described in our previous study [9] was used in the experimental groups in order The usage of press-fit cylinders in orthopaedics has been well-established in recent years [2,6].…”

“…A cylindrical graft, which in a clinical setup could be harvested from the proximal tibia, as described in our previous study [9] was used in the experimental groups in order The usage of press-fit cylinders in orthopaedics has been well-established in recent years [2,6]. However, its use in the treatment of pelvic non-unions in combination with a minimal invasive surgical technique has been described only in very few cases [9]. The stabilization of the pubic symphysis for the arthrodesis is usually performed with a cranial 3.5 symphyseal locking plate (SLDCP).…”

“…According to the literature [6,9], a tricortical bone block from the iliac crest of the synthetic pelvis served as control group in the present study. A cylindrical graft, which in a clinical setup could be harvested from the proximal tibia, as described in our previous study [9] was used in the experimental groups in order The usage of press-fit cylinders in orthopaedics has been well-established in recent years [2,6]. However, its use in the treatment of pelvic non-unions in combination with a minimal invasive surgical technique has been described only in very few cases [9].…”

“…The instability of the pubic symphysis can result from a traumatic rupture, but also results from non-traumatic conditions like osteitis pubis, sportive overuse with Fritz et al Journal of Experimental Orthopaedics (2023) 10:98 [9][10][11][12]. On top of the mentioned complications above, this procedure may result in delayed bone healing or even absence of consolidation of the bone graft.…”

“…The gold standard for a fusion of the symphysis is either one plate in cranial position or double plating with an additive “bumper” plate in 90°, in frontal plane of the symphysis [ 5 ]. Complications such as nerve irritation which could lead to a chronic pain syndrome, infection and also induced necrosis of the soft tissue, especially in the growing population of obese patients [ 9 – 12 ]. On top of the mentioned complications above, this procedure may result in delayed bone healing or even absence of consolidation of the bone graft.…”