Closed reduction and fixation of locked symphysis pubis using tubular external fixator: a case report

Abstract

Pelvic injuries usually occur in young adults as a result of high-energy trauma such as motor vehicle accidents or falling from a height; more rarely they occur in older people with osteoporosis as a result of low-energy trauma such as falling while standing. Sometimes one pubic bone is entrapped behind the other or opposite the obturator foramen. For treatment of this kind of injury closed reduction may be obtained in some cases and plate-screw fixation or external fixation can be used following open reduction when closed reduction cannot be obtained.We present a case of locked symphysis pubis treated by closed reduction using a tubular fixator and review the literature. CASE REPORTAfter being evaluated in another hospital due to an out of vehicle traffic accident, a 31-year-old female patient was in good general condition with normal consciousness when assessed in the emergency department of our hospital to which she was transferred. There was tenderness on the patient's symphysis pubis and in the lumbosacral region; in addition pelvic compression examination was painful. Neurological examination and the peripheral circulation of the patient were normal. On plain radiographs ( Figure 1) and computed tomography (CT) (Figure 2) scans of the patient the left pubis was locked overlapping the superoposterior right pubis and a non-displaced facet joint fracture of the S1 vertebra (Figure 3) was detected. There was no pathology in the patient's abdomen and pelvic organs.The next day the patient underwent surgery. First, a tubular fixator device with compression bars was placed in both iliac wings under fluoroscopic assistance. The locking situation was corrected by Simfiz pubisin kilitlenmesi, yandan gelen sıkıştırıcı kuvvetler sonrasında bir pubik kemiğin diğerinin arkasında ya da karşı obturator foramende takılı kaldığı bir pelvis yaralanması türüdür. Bu makalede 31 yaşında kadın hastada tübüler eksternal fiksatör kullanılarak kapalı redüksiyon ile tedavi edilen bir kilitli simfiz pubis olgusu sunuldu. Tübüler eksternal fiksatörlerin kilitli pelvis yaralanmalarında kapalı redüksiyon manevralarının uygulanmasında yararlı olduğuna ve bu cihazların açık redüksiyon gereksinimini azalttığı gibi, dahili implant kullanma gereksinimini de azaltacağına inanmaktayız.Anahtar sözcükler: Kapalı redüksiyon; kilitli simfizis pubis; tübüler eksternal fiksatör.Locked symphysis pubis is a kind of pelvic injury in which one pubic bone is jammed in the back of the other or opposite the obturator foramen following lateral compression forces. In this article, we present a 31-year-old female case of locked symphysis pubis which was treated by closed reduction using tubular external fixator. We believe that tubular external fixators are useful devices to perform closed reduction maneuvers for locked pelvic injuries and also help to reduce the need for open reduction and internal implant usage.