Treatment of Locked Pubic Symphysis by Distraction Osteotomy of the Superior Pubic Ramus

Abstract

Case: An 18-year-old adolescent sustained a lateral compression injury to the pelvis that featured a locked pubic symphysis with plastic deformation of the sacrum. The pubic bone was entrapped in the opposite obturator foramen and required a novel distraction osteotomy of the superior ramus to restore the symphysis. The patient developed a urethral stricture 3 months after injury that required urethroplasty. The symphysis remained in alignment without any morbidity at the osteotomy site over 13 months of follow-up. Conclusion: Locked pubic symphysis is frequently associated with urethral injuries. The distraction osteotomy of the superior pubic ramus described is a viable reduction maneuver that neutralizes the plastic deformation forces.

Percutaneous Treatment of Locked Pubic Symphysis with the Anterior Subcutaneous Pelvic Fixator (INFIX)

“…Alternatively, these injuries can be open reduced through the same approach, but then stabilized with an external fixator instead of plating 1,26 . In 2 rare cases, the reductions required a superior pubic ramus osteotomy, followed by either anterior plating 2 or external fixation 1 . Although many of these injuries usually require an open reduction, there have been some reports of these injuries being closed reduced alone using some basic maneuvers (e.g., flexion, abduction, and external rotation of the femur with external rotation of the hemipelvis through the iliac crest or lateral compression of the pelvis with a posterior force to the symphysis) 3,4,27-31 .…”

“…Pelvic ring injuries that result in a fixed overlapping dislocation of the pubic symphysis are a rare type of lateral compression injury. This pattern has been termed “the locked pubic symphysis” 1,2 because it often requires a significant intervention to address the dislocation. It was first described by Eggers in 1952 3 in which he proposed a mechanism of hyperextension and adduction or abduction of the femur that produced a lateral compression injury to the pelvic ring.…”

Irreducible Overlapping Pubic Symphysis Dislocation Managed with Distraction Osteotomy of the Contralateral Superior Pubic Ramus: A Rare Case Report

“…Both the authors report acute urethral injury in their cases; however, patients did well at the final follow-up. Pushpasekaran et al[ 4 ]also used similar technique of reduction as used by us and other two authors but they fixed the osteotomy site in buttress mode instead of neutral mode; their reason behind this mode of fixation being the prevention of implant failure by decreasing the stresses in the pelvis caused by plastic deformation. Posterior ring injury involving plastic deformation of sacrum and minimal sacroiliac joint injury was treated conservatively and there was no urinary injury at presentation in their case, but the patient developed secondary urethral stricture which required urethroplasty.…”

“…By definition, an overlapping pubic symphysis dislocation (OPSD) or a locked pubic symphysis is a lateral compression of the pelvic ring, with the intact pubis trapped into the contralateral obturator foramen [ 1 ]. Although this type of injury was originally described by Eggers [ 2 ] in 1952, only thrice before a similar technique of reduction has been reported [ 1 , 3 , 4 ].…”