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Case Reports
. 2024 Sep 14:54:101107.
doi: 10.1016/j.tcr.2024.101107. eCollection 2024 Dec.

Pubic symphysis tethering technique under endoscopic approach for treatment of pelvic open-book injury: A cadaver study

Pierre Emmanuel Moreau  1 , Ali Bokhari  1 , Sarah El Yahiouni  1 , Quentin Manach  1 , Peter Upex  1 , Guillaume Riouallon  1
Affiliations
Case Reports

Pubic symphysis tethering technique under endoscopic approach for treatment of pelvic open-book injury: A cadaver study

Pierre Emmanuel Moreau et al. Trauma Case Rep. .

Abstract

Purpose: Pubic symphysis disruption is common in pelvic trauma. Open reduction and internal fixation with a plate is the gold standard technique. Despite increasing interest in an endoscopic approach, the challenges of specific endoscopic instrumentation, reduction and fixation remains. In this feasibility cadaveric study, we aimed to describe a novel endoscopic technique of fixation of pubic symphysis disruption with a spinal vertebral tethering system.

Methods: Endoscopic pubic symphysis fixation with the tethering method was performed on a female cadaver specimen as well as an artificial pelvic model.

Results: We describe a step-by-step technique where three abdominal portals were utilized in order to insert screws in the pubic body and superior pubic ramus under endoscopic visualization. The synthetic tether ligament was introduced through a lateral portal and fixed and tensioned to reduce and compress the pubic symphysis.

Conclusions: While open plate fixation is the current gold standard of pubic symphysis disruption there is increasing interest in the minimally invasive endoscopic approach. In this feasibility cadaveric study, we present a new minimally invasive endoscopic fixation method to treat pubic symphysis disruption with a synthetic ligament.

Keywords: Laparoscopy; Minimally invasive surgery; Pelvic ring injury; Tethering.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Sawbone model with the final construct.
Fig. 2
Fig. 2
Surgical set up. A: Subombilical viewing portal. B: Lateral instrumental portal. C: Pubic symphysis.
Fig. 3
Fig. 3
Specific endoscopic instrumentation. A: “All-through-one” instrument: anchor inserter with long awl. B: 4.5 mm non cannulated tap. C: Sounder. D: Screwdriver.
Fig. 4
Fig. 4
Surgical steps on sawbone model. A: Locking the anchor on the anchor inserter. B: Impaction of the anchor in the pubic bone. C: Insertion of a 5.5 mm screw. D: Front view of the pelvis after positioning the four screws. E: The ligament is inserted and tensioned. F: Final construct.
Fig. 5
Fig. 5
Surgical steps under fluoroscopic control. A: Anchor and awl placement on the pubic body. B: First screw inserted in the pubis. C: Final construct.
Fig. 6
Fig. 6
Intraoperative endoscopic views. A: Screw insertion on the left pubic superior ramus. B: Ligament insertion. C: Final construct view under endoscopy.
See this image and copyright information in PMC

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