Is fixation failure after plate fixation of the symphysis pubis clinically important?

Abstract

Background: Plate fixation is a recognized treatment for pelvic ring injuries involving disruption of the pubic symphysis. Although fixation failure is well known, it is unclear whether early or late fixation failure is clinically important.

Questions/purposes: We therefore determined (1) the incidence and mode of failure of anterior plate fixation for traumatic pubic symphysis disruption; (2) whether failure of fixation was associated with the types of pelvic ring injury or pelvic fixation used; (3) the complications, including the requirement for reoperation or hardware removal; and (4) whether radiographic followup of greater than 1 year alters subsequent management.

Methods: We retrospectively reviewed 148 of 178 (83%) patients with traumatic symphysis pubis diastasis treated by plate fixation between 1994 and 2008. Routine radiographic review, pelvic fracture classification, method of fixation, incidence of fixation failure, timing and mode of failure, and the complications were recorded after a minimum followup of 12 months (mean, 45 months; range, 1-14 years).

Results: Hardware breakage occurred in 63 patients (43%), of which 61 were asymptomatic. Breakage was not related to type of plate, fracture classification, or posterior pelvic fixation. Five patients (3%) required revision surgery for failure of fixation or symptomatic instability of the symphysis pubis, and seven patients (5%) had removal of hardware for other reasons, including late deep infection in three (2%). Routine radiographic screening as part of annual followup after 1 year did not alter management.

Conclusions: Our observations suggest the high rate of late fixation failure after plate fixation of the symphysis pubis is not clinically important.

Fig. 1

An example of an open-book pelvic ring injury treated with symphysis pubis plating.

Fig. 2

The number of screws used for anterior fixation.

Fig. 3

An example of a pelvic ring injury with disruption of the symphysis pubis, both rami, and both sacroiliac joints stabilized using anterior and posterior fixation using a plate extended across the rami.

Fig. 4

The timing of initial hardware breakage.

Fig. 5

An example of hardware breakage of symphysis pubis screws (left) and plate (right) with no subsequent displacement.