Open reduction and internal fixation of a traumatic diastasis of the pubic symphysis

Abstract

The aim of this study was to review the number of patients operated on for traumatic disruption of the pubic symphysis who developed radiological signs of movement of the anterior pelvic metalwork during the first post-operative year, and to determine whether this had clinical implications. A consecutive series of 49 patients undergoing internal fixation of a traumatic diastasis of the pubic symphysis were studied. All underwent anterior fixation of the diastasis, which was frequently combined with posterior pelvic fixation. The fractures were divided into groups using the Young and Burgess classification for pelvic ring fractures. The different combinations of anterior and posterior fixation adopted to stabilise the fractures and the type of movement of the metalwork which was observed were analysed and related to functional outcome during the first post-operative year. In 15 patients the radiographs showed movement of the anterior metalwork, with broken or mobile screws or plates, and in six there were signs of a recurrent diastasis. In this group, four patients required revision surgery; three with anterior fixation and one with removal of anterior pelvic metalwork; the remaining 11 functioned as well as the rest of the study group. We conclude that radiological signs of movement in the anterior pelvic metalwork, albeit common, are not in themselves an indication for revision surgery.

Implantatentfernung nach Beckenringfraktur

“…Dahingegen wird die Indikationsstellung zur Materialentfernung kontrovers diskutiert [4,7,8,16,18,27,30]. Insbesondere findet sich in der Literatur bislang keine ausreichende Evidenz in Form von randomisierten kontrollierten Studien mit der Fragestellung der Implantatentfernung nach Beckenringfraktur.…”

“…Abb. 5; [8,16]). Im Bereich der Iliosakralfuge wird durch die Verschraubung die physiologische Gelenkbewegung im Sinne einer Arthrodese transfixiert, d. h. das überwiegend vertikale Bewegungsmuster der Amphiarthrose bei der Lastübertragung von der Wirbelsäu-le auf den Beckenring wird aufgehoben [5].…”

“…Jedoch wurden bislang die Indikationen zur Entfernung des Osteosynthesematerials bei Patienten mit Beckenringverletzungen in der Literatur kaum thematisiert und zudem kontrovers diskutiert [2,4,7,8,16,18,27,30]. So findet man zum einen die Empfehlung, gelenkübergreifende Implantate, wie z.…”

Classifications in Brief: Young and Burgess Classification of Pelvic Ring Injuries

“…They also found an unexpectedly high rate of fixation failure with loss of reduction of 22% for isolated APC II pelvic ring injuries treated with anterior multiple-hole plate fixation alone [19]. Putnis et al [15] also found six of 43 patients treated surgically for APC injuries had anterior fixation failure and loss of reduction; all of these were APC II injuries treated with isolated anterior fixation and no posterior iliosacral screws. The role for posterior pelvic fixation with APC II pelvic fractures remains unclear and debated [18].…”

What is the best internal fixation in pelvic fracture models with open-book injury and anterior sacroiliac joint disruption?

“…Failure of open reduction and internal fixation of diastasis symphysis as a result of trauma was described by Putnis et al 11 Fifteen patients (31%) experienced anterior shifting of plate or screw, 10 patients experienced screw loosening or damage. Anterior fixation alone was the most frequent cause of treatment failure (n=7; 47%), followed by anterior fixation with unilateral sacroiliac fixation (n=6; 40%) and bilateral sacroiliac fixation (n=2; 13%).…”