The radiographic outcome after plating for pubic symphysis diastasis: does it matter clinically?

Abstract

Introduction Open reduction and internal fixation with plates is the most widespread surgery in traumatic pubic symphysis diastasis. However, implant failure or recurrent diastasis was commonly observed during follow-up. The aim of our study was to evaluate the radiologic findings and clinical outcomes. Materials and methods Sixty-five patients with traumatic pubic symphysis diastasis treated with plating between 2008 and 2019 were retrospectively reviewed. The exclusion criteria were a history of malignancy and age under 20 years. Radiographic outcomes were determined by radiograph findings, including pubic symphysis distance (PSD) and implant failure. Clinical outcomes were assessed according to the Majeed score at the final follow-up. Results Twenty-eight patients were finally included. Nine patients (32%) experienced implant failure, including four (14%) with screw loosening and five (18%) with plate breakage. Only one patient underwent revision surgery. Postoperatively, a significant increase in PSD was observed at 3 months and 6 months. Postoperative PSD was not significantly different between patients with single plating and double plating, but it was significantly greater in the implant-failure group than in the non-failure group. The Majeed score was similar between patients with single plating and double plating or between the implant-failure group and the non-failure group. Body mass index, number of plates, age, and initial injured PSD were not significantly different between the implant-failure group and the non-failure group. Only a significant male predominance was observed in the implant-failure group. Conclusion A gradual increase in the symphysis distance and a high possibility of implant failure may be the distinguishing features of traumatic pubic symphysis diastasis fixation. The postoperative symphyseal distance achieved stability after 6 months, even after implant failure. Radiographic outcomes, such as increased symphysis distance, screw loosening, and plate breakage, did not affect clinical 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

“…The Majeed Pelvic Score was higher in the implant failure group after adjusting it to the previous work of patients. 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 ].…”

“…As in the study of Frietman et al no predictors of implant failure in patients’ demographics could be detected [ 15 ]. Tseng et al reported, that males suffer more often from implant failure [ 19 ]. Due to the gender inhomogeneity of the cohort presented here, with 93% male patients, this finding could either be proven or disproven.…”

“…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 ].…”

Reconstruction with 3D-printed prostheses after type I + II + III internal hemipelvectomy: Finite element analysis and preliminary outcomes

“…At the same time, the adductor muscles and hamstring muscles could be reattached anatomically, ensuring better functional recovery and pain improvement. However, the natural pubic symphysis permits a minute shift of 2 mm and 1° of rotation, which prevents stress fracture under peak loading ( Hammer et al, 2019 ; Tseng et al, 2022 ). After rigid prosthetic reconstruction of region III, the pubic symphysis bore greater vertical deformation than the other parts ( Dong et al, 2014 ).…”

Symphyseal plating for pelvic fracture in a morbidly obese patient: operative challenges and innovation of a novel ‘wire-ramp plate-sliding method’

“…However, there are certain challenges depending on the patient profile, pattern of fractures and degree of displacement. Although it is one of the easier surgeries, there are often high failure rates, mostly due to the backout of screws and eventual implant failure which necessitates resurgery 2–4. Morbid obesity makes the otherwise simple surgery quite challenging due to difficult exposure and reduction, requirement of working at a depth and difficulties in screw trajectory due to pendulous abdomen 5–11.…”