Percutaneous screw fixation of pubic symphysis disruption: A preliminary report

Abstract

Background: Percutaneous techniques are commonly used to treat pelvic ring disruptions but are not mainstream for fixation of pubic symphysis disruption worldwide. Potential advantages include less blood loss and lower risk of surgical site infection, especially in the morbidly obese or multiply injured patient. This study was performed to describe the clinical and radiographic outcomes of patients after percutaneous reduction and screw fixation of pubic symphysis disruption and to evaluate the preliminary safety and efficacy of this technique and its appropriateness for further study as an alternative method of fixation.

Methods: A retrospective review was performed to identify all patients who underwent percutaneous fixation of pubic symphysis disruption by two surgeons at an academic Level I trauma center over a 3-year period. Patients underwent percutaneous reduction and fixation of the pubic symphysis using 1 or 2 fully or partially threaded 5.5, 6.5, or 7.3 mm cannulated screws in a transverse or oblique configuration. Associated posterior ring injuries were fixed with trans-sacral and/or iliosacral screws. The primary outcome of interest was loss of reduction, defined as symphysis distance greater than 15 mm measured on final AP pelvis radiograph. Secondary outcomes collected by chart review were operative time, blood loss, vascular or urologic injury, sexual dysfunction, infection, implant loosening or breakage, and revision surgery.

Results: Twelve patients met criteria and primary and secondary outcomes were collected. Mean clinical and radiographic follow-up were 15 months each. One patient lost reduction. Mean operative time and blood loss were 124 min and 29 cc, respectively. No vascular or urologic injuries occurred. Two patients reported sexual dysfunction. No patients became infected or required revision surgery. Four patients underwent implant removal. Seventeen additional patients were excluded due to short follow-up and limited outcomes were collected. Two of these patients lost reduction. Three underwent implant removal.

Conclusion: These data support percutaneous reduction and screw fixation of pubic symphysis disruption as a potentially safe and effective method of treatment that warrants further investigation.

Fig. 1

Radiographs of a 25-year-old male who sustained an AO/OTA 61-B injury by motor vehicle crash. AP (A), inlet (B), and outlet (C) views reveal the injury characteristics including disruption of the pubic symphysis. Radiographs immediately after surgery show the reduction and fixation achieved percutaneously (D–F). Final follow-up radiographs at 15 months demonstrate maintenance of reduction with final AP symphysis distance 4.4 mm (G–I).

Fig. 2

AP radiographs of a 38 year-old obese male who sustained an AO/OTA 61-B injury by motor pedestrian collision at time of injury (A), 2 weeks post-operative (B) 19 months postoperative when implant loosening and migration became apparent (C), and 20 months postoperative after implant removal (D). Note final AP symphysis distance 5.8 mm without loss of reduction of the anterior ring.

Fig. 3

AP radiographs of a 76 year-old male who sustained an AO/OTA 61-C injury after a fall from height at the time of injury (A), immediately post-operative (B), 10 weeks post-operative (C) and 27 months post-operative (D). Note the loss of reduction was progressing at 10 weeks and the implants showed further migration at 27 months, although the patient remained asymptomatic.