MyPACS.net: Radiology Teaching Files > Case 55817361

Never visited LOCKED PUBIC SYMPHYSIS
Contributed by: Dr.A.Mohan Krishna, Surgeon, APOLLO HOSPITALS,JUBILEE HILLS,HYDERABAD, India.
Patient: 27 year old male
History:

 

27 YEARS OLD MALE CAME WITH INJURY TO PELVIS FOLLOWING RTA ON 6/3/2005. THE MODE OF INJURY WAS THAT WHILE THE AUTO RICKSHAW HE WAS RIDING TOPPLED OFF. HE WAS TAKEN TO LOCAL HOSPITAL WHERE PRIMARY RESUSCITATION  AND SUPRAPUBIC CATHETERISATION WAS DONE. PATIENT WAS REFERRED TO HIGHER CENTRE FOR FURTHER MANAGEMENT.

 

Images:[small]larger

Fig. 1: LOCKED PUBIC SYMPHYSIS PREOPERATIVE RADIOGRAPH

Fig. 2: LOCKED PUBIC SYMPHYSIS POSTOPERATIVE RADIOGRAPH
Findings:

LOCAL EXAMINATION

SUTURED WOUND 1CM OVER BOTH ILIAC CRESTS,

PELVIC COMPRESSION TEST WAS POSITIVE,

SUPRPUBIC CATHETER IN PLACE DRAINING CLEAN URINE.

HEMODYNAMICALLY STABLE.

INTRAOPERATIVE FINDINGS: 

  • UNDER GA
  • SUPINE POSITION
  • PFANNENSTIEL INCISION
  • RECTI INCISED IN THEIR LOWER 1/3RDS
  • BILATERAL PUBIC PUBI RAMI AND SYMPHYSIS EXPOSED AND REDUCED MANUALLY AND HELD WITH POINTED REDUCTION BONE CLAMPS,
  • TWO SCREWS PASSED INTO THE PUBIS IN SUPERIO INFERIO DIRECTION AND TBW DONE TO HOLD THE SYMPHYSIS.
  • UROLOGIST STANDBY PASSED CATHETER PU AND COMPLETE URETHRAL DISRUPTION WAS NOTED.
  • WOUND CLOSED IN LAYERS.

POSTOPERATIVE PERIOD

POSTOPPERIOD WAS UNEVENTFUL AND PATIENT WAS DISCHARGED WITH ADVICE OF ABSOLUTE BED REST, WITH SUPRAPUBIC CATHETERISATION

Diagnosis: A CASE OF TRAUMATIC LOCKED PUBIC SYMPHYSIS
Discussion:

A proposed mechanism of injury for a locked symphysis is forced hyperextension and adduction of the hip resulting from a lateral compression force to the pelvis. This injury causes a rupture of the ligaments that normally stabilise the symphysis. The displaced pubis may lie either anterior or posterior to the contralateral pubis. This injury is commonly associated with urogenital injuries.
 
Very little was written in literature about management of such injuries though closed and open reduction techniques were described. Closed reduction is difficult to achieve and also difficult to maintain. Open reductions are associated with high rate of infections due to associated urogenital injuries. Hence it is important to minimise the metal work used to fix the dislocation, yet to get a stable fixation. In this case the two screws used were placed in a staggered fashion, postero superiorly on the pubis displaced posteriorly and antero superiorly on the anteriorly placed pubis bone. Tightening the tension band wire will exert a reducing force while maintaining the compression across the symphysis. 

A proposed mechanism of injury for a locked symphysis is forced hyperextension and adduction of the hip resulting from a lateral compression force to the pelvis. This injury causes a rupture of the ligaments that normally stabilise the symphysis. The displaced pubis may lie either anterior or posterior to the contralateral pubis. This injury is commonly associated with urogenital injuries.

Very little was written in literature about management of such injuries though closed and open reduction techniques were described. Closed reduction is difficult to achieve and also difficult to maintain. Open reductions are associated with high rate of infections due to associated urogenital injuries. Hence it is important to minimise the metal work used to fix the dislocation, yet to get a stable fixation. In this case the two screws used were placed in a staggered fashion, postero superiorly on the pubis displaced posteriorly and antero superiorly on the anteriorly placed pubis bone. Tightening the tension band wire will exert a reducing force while maintaining the compression across the symphysis. 

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Additional Details:

Case Number: 55817361Last Updated: 2011-10-01
Anatomy: Skeletal System   Pathology: Trauma
Modality: Conventional Radiograph, PhotographAccess Level: Readable by all users

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