Fixation failure in patients with traumatic diastasis of pubic symphysis: impact of loss of reduction on early functional outcomes

Abstract

Background Failure of fixation (FF) in pubic symphysis diastasis (SD) ranges between 12 and 75%, though whether it influences functional outcomes is still debated. The objective of this study is to evaluate the impact of anterior pelvic plate failure and loss of reduction on Majeed’s functional scores. Methods Single center retrospective review of consecutive patients with acute SD treated by means of anterior pubic plating. Thirty-seven patients with a mean age 45.7 ± 14.4 years were included. Demographics, AO classification, pelvic fixation and secondary procedures were recorded. Majeed’s functional scores at minimum 6 months follow-up were compared according to the presence of FF and loss of reduction. Results Fifteen patients presented FF. Eight presented an additional loss of symphyseal reduction. Mean Majeed´s score (MMS) in patients with and without FF was 64.4 ± 13.04 and 81.8 ± 15.65, respectively (p = 0.0012). Differences in MMS in patients without FF and those with FF and maintained or loss of anterior reduction were 11.3 [70.5 vs 81.8] (p = 0.092) and 22.7 [59.1 vs 81.8] (p = 0.001), respectively. Significant association of FF with AO classification was noted. (OR 12.6; p = 0.002). Conclusions Differences in MMS in the analyzed groups suggest that loss of reduction might be more relevant than failure of the anterior osteosynthesis in functional outcomes.

The clinical relevance of fixation failure after pubic symphysis plating for anterior pelvic ring injuries: an observational cohort study with long-term follow-up

“…Such instabilities could be addressed with an additional posterior fixation resulting in a reduction of implant failure [ 12 ]. However, the present study as well as previous studies were unable to support these finding [ 5 , 6 , 15 , 18 , 19 ].…”

“…The implant failure rate of 37% is comparable to previous reports [ 12 , 15 , 18 , 19 ]. Furthermore, the median time to implant failure of approximately 10 weeks is comparable to Rojas et al (seven weeks), Eastman et al (13 weeks) and Avilucea (16 weeks) et al but earlier than reported by Morris et al (one year) [ 5 – 7 , 12 ].…”

“…Conflicting reports exist, regarding the effect of fracture severity according to the AO classification, and it is poorly documented for the Young and Burgess classification [ 5 , 6 , 15 , 20 ]. The advantage of our study is the use of both the Young and Burgess and AO classification, particularly because of the conflicting recommendations for comparable injuries associated with the use of different classification systems.…”

“…Compared to previous studies, the Majeed Pelvic Score was higher in the present study [ 15 , 18 , 19 , 24 , 25 ]. However, there are differing opinions on the impact of implant failure on the functional outcome as followed: no impact [ 19 , 26 ], a tendency for better outcome without significance for intact implants [ 5 , 17 ] or implant failure [ 15 ]. In the present study, the implant failure group showed a significantly better outcome adjusting the Majeed Pelvic Score to the work category.…”

“…Currently, possible predictors of implant failure, such as anterior plate type [ 6 , 17 , 18 ], posterior stabilization [ 12 , 18 ], fracture classification [ 5 , 6 ] or demographics [ 15 , 19 ] are controversially discussed. Furthermore, the clinical relevance of implant failure remains unclear due to conflicting reports and a low revision rate [ 6 , 15 , 17 , 20 ].…”