Internal fixation of pubic symphysis diastasis with a tension banding technique

doi:10.1016/0020-1383(90)90007-H

Injury

Volume 21, Issue 4, July 1990, Pages 223-224

https://doi.org/10.1016/0020-1383(90)90007-H Get rights and content

Abstract

We present the details of a method of internally fixing diastasis of the pubic symphysis with stout wires and a tension band which can be employed with speed and ease, through a minimal exposure or minimally extended laparotomy wound. The technique is suitable for those with little experience of internal fixation of the pelvis. Our initial cases are presented.

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Cited by (14)

Early failure of symphysis pubis plating
2016, Injury
Citation Excerpt :
Surgical intervention with accurate reduction and stable fixation restores pelvic ring alignment, stability, and allows early patient mobilization [3–5]. Traumatic symphysis pubis disruptions have been managed using both external and internal fixation methods [6–11]. Numerous internal fixation methods have been described including screws and wires, two and multi-hole plates, box-plates, and dual plating constructs [12–17].
Operative fixation of a disrupted symphysis pubis helps return alignment and stability to a traumatized pelvic ring. Implant loosening or failure has been demonstrated to commonly occur at some subacute point during the postoperative period. The purpose of this study is to report on a series of patients with traumatic pelvic ring disruptions to determine the incidence and common factors associated with early postoperative symphyseal plate failure before 7 weeks.
126 patients retrospectively identified with unstable pelvic injuries treated with open reduction and plate fixation of the symphysis pubis and iliosacral screw fixation. Preoperative and postoperative radiographs, computed tomography (CT) images, and medical chart were reviewed to determine symphyseal displacement preoperatively and postoperatively, time until plate failure, patient symptoms and symphyseal displacement at failure, subsequent symphyseal displacement, incidence of additional surgery, and patient weight bearing compliance.
14 patients (11.1%) sustained premature postoperative fixation failure. 13 patients had anteroposterior compression (APC)-II injuries and 1 patient had an APC-III injury. Preoperative symphyseal displacement was 35.6 millimeters (mm) (20.8-52.9). Postoperative symphyseal space measurement was 6.3 mm (4.7-9.3). Time until plate failure was 29 days (5–47). Nine patients (64.2%) noted a pop surrounding the time of failure. Symphyseal space measurement at failure was 12.4 mm (5.6-20.5). All patients demonstrated additional symphyseal displacement averaging 2.6 mm (0.2-9.4). Two patients (14.2%) underwent revision. Four patients (28.5%) were non-compliant.
Premature failure of symphysis pubis plating is not uncommon. In this series, further symphyseal displacement after plate failure was not substantial. The presence of acute symphyseal plate failure alone may not be an absolute indication for revision surgery. Making patient education a priority could lead to decreased postoperative non-compliance and potentially a decreased incidence of implant failure. Posterior pelvic ring fixation aides overall pelvic ring stability and may help minimize further displacement after early postoperative symphyseal plate failure. Further functional outcome and biomechanical studies surrounding early symphyseal plate failure are needed.
Implant retention and removal after internal fixation of the symphysis pubis
2005, Injury
Although internal fixation of diastasis of the symphysis pubis is commonly performed, there are no clear guidelines regarding the indications for removal of these implants. The long-term physiologic effects of retaining these internal fixation devices are not well described. We surveyed the literature to assess the current thinking and recommendations regarding implant retention and removal. Twenty-four case series and two case reports were found, for a total of 482 cases. Complications arose as a result of implant retention in 7.5% of patients, with infection the most common complication. There is no consensus in the literature regarding implant retention and removal after internal fixation of diastasis of the symphysis pubis.
Biomechanics of pelvic fixation
1997, Orthopedic Clinics of North America
Effects of method of internal fixation of symphyseal disruptions on stability of the pelvic ring
1995, Injury
This study tested different methods of internal fixation of a symphyseal disruption, in comparison with the mechanics of the intact pelvis. Unembalmed cadaveric pelves were tested in simulated bilateral stance in a servohydraulic materials-testing machine. Motion of the superior and inferior pubic symphysis, and at two lefels of the posterior sacroiliac complex, was measured using high resolution displacement transdsucers. The fixations tested were (1) double plating (4.5 mm reconstruction plates), (2) wire loops around two 6.5 mm, fully threaded cancellous screws, and (3) an absorbable suture material (polydioxanone). Each pelvis was first tested intact, recording displacements in response to a cyclic axial load up to a maximum of 500 N applied through the proximal sacrum. The pubic symphysis was then sectioned and the sacrum fractured to produce an unstable pelvis (Tile C-type). Recordings were then repeated, following fixation of the sacral fructure with lag screws and sequential fixation of the symphysis with each of the test methods. The results from eight pelves revealed that internally fixed symphyseal motion was generally greater than intact, regardless of fixation method. The superior symphysis was usually compressed, while there was distraction inferiorly. Wiring resulted in significantly less symphyseal motion than the other methods (P<0.02), provided four loops were used, reducing the separation inferiorly. There was no significant difference in sacral fracture motion between the three methods. The results indicate that in osteoporotic bone, as used in this study, symphyseal wiring is best able to oppose the tensile loads in the inferior symphysis that are associated with bilateral stance loading. These biomechanical findings must be interpreted within the broader context of surgical management of these complex injuries.
Fixation of the pubic symphysis
1993, Operative Techniques in Orthopaedics
Internal fixation of a disrupted pubic symphysis is an attractive option when this injury is a component of an unstable pelvis. Posterior stability is also required and may be provided by residual ligamentous integrity or by separate posterior repair, depending on the patient's injury. Open reduction internal fixation of the symphysis can be done through a midline laparotomy or a Pfannenstiel incision. A two-hole dynamic compression plate with fully threaded 6.5-mm cancellous screws is recommended. External fixation may be preferable initially if emergency stabilization is needed to control hemorrhage and the abdomen is not already open.
Trans-obturator cable fixation of open book pelvic injuries
2021, Scientific Reports

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Internal fixation of pubic symphysis diastasis with a tension banding technique

Abstract

The abbreviated injury scale, 1985 revision: a condensed chart for clinical use

J. Trauma

Occult injuries of the pelvic ring

Clin. Orthop.

Pelvic ring disruptions with symphysis pubis diastasis

Clin. Orthop.