Hip Pelvis.  2017 Jun;29(2):150-153. 10.5371/hp.2017.29.2.150.

Outcome of Internal Fixation and Corticocancellous Grafting of Symphysis Pubis Diastasis Which Developed after Malunion of Pubic Rami Fracture

• Bombaci H

• KMID: 2424245
• DOI: http://doi.org/10.5371/hp.2017.29.2.150

Abstract

We report a case of pubic symphysis diastasis, which was initially asymptomatic; however, it became symptomatic with urinary incontinence during pregnancy. The patient was treated with open reduction and internal fixation of the symphysis pubis. A corticocancellous autograft was used for filling the gap which remained despite bilateral compression of the iliac bones. We obtained satisfactory outcome in terms of symptoms at the 3 years' follow-up; however, there was instability findings in the X-rays with broken screws. We conclude that asymptomatic pubic symphysis diastasis might be symptomatic after additional trauma (such as pregnancy) in the following days, if it was unstable in the very beginning of injury. Fixation of old pubic symphysis diastasis with reconstruction plate by filling the gap by using corticocancellous autograft, might not prevent ultimate implant failure if the symphysis pubis diastasis is part of an unstable pelvic fracture in the very beginning.

Keyword

Pubis; Symphysis; Diastasis; Pelvis; Fracture

MeSH Terms

Autografts
Follow-Up Studies
Humans
Pelvis
Pregnancy
Pubic Bone
Pubic Symphysis Diastasis*
Transplants*
Urinary Incontinence

Figure

• 

  Fig. 1 Anteroposterior pelvis X-ray of patient just after fixation of the pelvis with external fixator. Although the symphysis pubis diastasis is reduced, the pubic bone looks displaced.

• 

  Fig. 2 Anteroposterior pelvis X-ray. Wide separation of pubic symphysis is seen with malunited pubic ramii fractures on the right side.

• 

  Fig. 3 Three-dimensional reconstruction of the pelvis. Notice the malunited the right pubic rami and symphysis pubis disruption. The fracture initially was treated with an external fixator.

• 

  Fig. 4 Early post-operative anteroposterior pelvic radiograph. Pubic symphysis is fixed with reconstruction plate by using autograft. Remaining gap is filled with corticocansellous autograft harvested from the contra lateral iliac bone.

• 

  Fig. 5 Single leg standing anteroposterior pelvis radiograph. Some screws are broken (white arrow), however there is no further displacement of the pelvic ring under stress.

Reference

1. Starr AJ, Malekzadeh AS. Fractures of the pelvic ring. In : Bucholz RW, Heckman JD, Court-Brown C, editors. Fractures in adults. 6th ed. Philadelphia: Lippincott Williams&Wilkins;2001. p. 1583–1664.

2. Oransky M, Tortora M. Nonunions and malunions after pelvic fractures: why they occur and what can be done? Injury. 2007; 38:489–496.

3. Pennal GF, Massiah KA. Nonunion and delayed union of fractures of the pelvis. Clin Orthop Relat Res. 1980; (151):124–129.

4. Burgess AR, Eastridge BJ, Young JW, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990; 30:848–856.

5. Klutke CG, Siegel CL. Functional female pelvic anatomy. Urol Clin North Am. 1995; 22:487–498.

6. Seth S, Das B, Salhan S. A severe case of pubic symphysis diastasis in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2003; 106:230–232.

7. Shim JH, Oh DW. Case report: physiotherapy strategies for a woman with symphysis pubis diastasis occurring during labour. Physiotherapy. 2012; 98:89–91.

8. Yoo JJ, Ha YC, Lee YK, Hong JS, Kang BJ, Koo KH. Incidence and risk factors of symptomatic peripartum diastasis of pubic symphysis. J Korean Med Sci. 2014; 29:281–286.

9. Seckiner I, Keser S, Bayar A, Yesilli C, Mungan A. Successful repair of a bladder herniation after old traumatic pubic symphysis diastasis using bone graft and hernia mesh. Arch Orthop Trauma Surg. 2007; 127:655–657.

10. Morris SA, Loveridge J, Smart DK, Ward AJ, Chesser TJ. Is fixation failure after plate fixation of the symphysis pubis clinically important? Clin Orthop Relat Res. 2012; 470:2154–2160.