scholarly journals Irreducible Overlapping Pubic Symphysis Dislocation Managed with Distraction Osteotomy of the Contralateral Superior Pubic Ramus: A Rare Case Report

2021 ◽  
Vol 11 (7) ◽  
Author(s):  
Rakesh Rajput ◽  
Ajay Kumar Goel ◽  
Ananda Mandal
Keyword(s):  
Case Report ◽  
Pelvic Ring ◽  
Pubic Symphysis ◽  
Urethral Injury ◽  
Osteotomy Site ◽  
Compression Injury ◽  
Pubic Ramus ◽  
Obturator Foramen ◽  
Superior Pubic Ramus ◽  
Si Joint

Introduction: Overlapping pubic symphysis dislocation (OPSD) or a locked pubic symphysis is a compression of the pelvic ring with the intact pubis trapped into the contralateral obturator foramen. Reduction can be difficult and contralateral suprapubic osteotomy is a good way to address the irreducible OPSD. The technique has only been discussed thrice in the available literature. Case Report: We report the case of a 26-year-old man who had his right pubic ramus entrapped within the contralateral obturator foramen, having an overlap of >4 cm with associated ipsilateral sacroiliac joint (SI joint) disruption and urethral injury. When all the maneuvers of closed and instrumented open reduction failed, we performed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus. The osteotomy site was stabilized with a 6-hole recon plate and SI joint was stabilized with a 6.5mm percutaneous sacroiliac screw. The patient underwent delayed urethral repair at 10 weeks after the index surgery. At 3-year follow-up, the patient did not report any pubic discomfort, urinary and sexual problems. Conclusion: Locked OPSD is a rare injury and is frequently associated with sacroiliac and urethral injuries. Distraction osteotomy of the contralateral superior pubic ramus is a viable option for irreducible cases. Keywords: Lateral compression injury, locked symphysis pubis, superior pubic ramus osteotomy, overlapping pubic symphysis dislocation.

Treatment of Locked Pubic Symphysis by Distraction Osteotomy of the Superior Pubic Ramus

2020 ◽  
Vol 10 (2) ◽  
pp. e0196-e0196
Author(s):  
Narendran Pushpasekaran ◽  
Sujith Thampy ◽  
Veliyaveettil Muhamed Khaleel ◽  
Sachin Joseph
Keyword(s):  
Pubic Symphysis ◽  
Pubic Ramus ◽  
Superior Pubic Ramus

Integrity of the pectineal ligament in MRI correlates with radiographic superior pubic ramus fracture displacement

2020 ◽  
pp. 028418512091300
Author(s):  
Alexis Klengel ◽  
Hanno Steinke ◽  
Philipp Pieroh ◽  
Andreas Höch ◽  
Timm Denecke ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Pelvic Ring ◽  
Compression Fracture ◽  
Strong Positive Correlation ◽  
Lateral Compression ◽  
Pubic Ramus ◽  
Radiographic Appearance ◽  
Fracture Displacement ◽  
Superior Pubic Ramus ◽  
Magnetic Resonance Imaging Mri

Background Estimating the stability of pelvic lateral compression fractures solely by static radiographs can be difficult. In this context, the role of anterior pelvic soft tissues as potential secondary stabilizer of the pelvic ring has hardly been investigated. Purpose To correlate the initial radiographic appearance of the pubic ramus fracture with the integrity of the pectineal ligament, a strong ligament along the pecten pubis. Material and Methods In total, 31 patients with a pelvic lateral compression fracture (AO/OTA 61- B1.1/B2.1) with 33 superior pubic ramus fractures and available post-traumatic radiographs (pelvis anteroposterior, inlet, outlet) and magnetic resonance imaging (MRI) of the pelvis with fat-suppressed coronal images were reviewed retrospectively. Radiographic superior pubic ramus fracture displacement was measured and correlated to the degree of MR-morphologic alterations of the pectineal ligament (grade 0 = intact, grade 3 = rupture). Results In the majority of fractures (72.7%), associated MR-morphologic alterations of the pectineal ligament were present. Radiographic displacement and MRI grading showed a strong positive correlation (Spearman rho = 0.783, P < 0.001). The sensitivity and specificity for a radiographic displacement of >3 mm on plain radiographs to detect a structural ligament lesion on MRI (grade 2 and higher) were 73% and 100%, respectively. Conclusion Radiographic displacement of superior pubic ramus fractures >3 mm is a strong indicator for a structural lesion of the pectineal ligament. Future studies should investigate the potential biomechanical importance of this ligament for pelvic ring stability.

scholarly journals The Influence of Pelvic Ramus Fracture on the Stability of Fixed Pelvic Complex Fracture

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Jianyin Lei ◽  
Yue Zhang ◽  
Guiying Wu ◽  
Zhihua Wang ◽  
Xianhua Cai
Keyword(s):  
Pelvic Fracture ◽  
Pelvic Ring ◽  
Stable Condition ◽  
Pubic Symphysis ◽  
Pelvic Bone ◽  
Anterior Plate ◽  
Fe Method ◽  
Pubic Ramus ◽  
Complex Fracture ◽  
The Stability

This study aims to evaluate the biomechanical mechanism of pelvic ring injury for the stability of pelvis using the finite element (FE) method. Complex pelvic fracture (i.e., anterior column with posterior hemitransverse lesion) combined with pelvic ramus fracture was used to evaluate the biomechanics stability of the pelvis. Three FE fracture models (i.e., Dynamic Anterior Plate-Screw System for Quadrilateral Area (DAPSQ) for complex pelvic fracture with intact pubic ramus, DAPSQ for complex pelvic fracture with pubic ramus fracture, and DAPSQ for complex pelvic fracture with fixed pubic ramus fracture) were established to explore the biomechanics stability of the pelvis. The pubic ramus fracture leads to an unsymmetrical situation and an unstable situation of the pelvis. The fixed pubic ramus fracture did well in reducing the stress levels of the pelvic bone and fixation system, as well as displacement difference in the pubic symphysis, and it could change the unstable situation back to a certain extent. The pelvic ring integrity was the prerequisite of the pelvic stability and should be in a stable condition when the complex fracture is treated.

scholarly journals Management and outcome of pelvic fracture associated with vaginal injuries: a retrospective study of 25 cases

2019 ◽  
Author(s):  
Pengyu Li ◽  
Dongsheng Zhou ◽  
Baisheng Fu ◽  
Wenhao Song ◽  
Jinlei Dong
Keyword(s):  
Retrospective Study ◽  
Pelvic Fracture ◽  
Influence Factor ◽  
Pelvic Ring ◽  
Delayed Diagnosis ◽  
Pubic Symphysis ◽  
Pelvic Fractures ◽  
Urethral Injury ◽  
Pelvic Ring Fractures ◽  
Vaginal Injury

Abstract Backgound: Pelvic ring fractures associated with vaginal injuries were rarely reported due to low incidence. The displaced segments of pelvic ring may increase the risk of vaginal injury. The aim of this retrospective study was to evaluate the correlation between pelvic fracture and vaginal injury. Methods: We conducted a retrospective review of 25 patients with pelvic fractures associated with vaginal injury treated at our institution. The medical records of these patients were collected and 24 patients were followed-up for 10-36 months. Results: All patients suffered anterior pelvic ring fracture. Young-Burgess fracture classification and compromised pubic symphysis were related to severity vaginal injury. Gauze packing was done in 6 patients and 18 patients received surgical repair. Infection occurred in 6 patients among them 4 were due to delayed diagnosis. Factors associated with pelvic outcome were age, urethral injury, and infection. Four patients suffered pain in sexual intercourse but no influence factor found correlated to sexual function. Conclusion: VS type pelvic fractures and compromised pubic symphysis are related to higher severity of vaginal injury. Disruption of anterior ring and an unstable pelvic ring caused by forces on coronary and axial plane may increase the risk of vaginal injury. Key words: Pelvic fracture, Vaginal injury, Clinical outcome

SUPERIOR PUBIC RAMUS OSTEOTOMY TO TREAT LOCKED PUBIC SYMPHYSIS

2006 ◽  
Vol 88 (7) ◽  
pp. 1609-1614 ◽  
Author(s):  
ROBERT V. OʼTOOLE ◽  
CARLOS SAGEBIEN ◽  
ROMNEY C. ANDERSEN ◽  
JASON W. NASCONE
Keyword(s):  
Pubic Symphysis ◽  
Pubic Ramus ◽  
Superior Pubic Ramus

Superior Pubic Ramus Osteotomy to Treat Locked Pubic Symphysis

2006 ◽  
Vol 88 (7) ◽  
pp. 1609-1614 ◽  
Author(s):  
Robert V. OʼToole ◽  
Carlos Sagebien ◽  
Romney C. Andersen ◽  
Jason W. Nascone
Keyword(s):  
Pubic Symphysis ◽  
Pubic Ramus ◽  
Superior Pubic Ramus

scholarly journals Management and outcome of pelvic fracture associated with vaginal injuries: a retrospective study of 25 cases

2019 ◽  
Author(s):  
Pengyu Li ◽  
Dongsheng Zhou ◽  
Baisheng Fu ◽  
Wenhao Song ◽  
Jinlei Dong
Keyword(s):  
Retrospective Study ◽  
Pelvic Fracture ◽  
Influence Factor ◽  
Pelvic Ring ◽  
Delayed Diagnosis ◽  
Pubic Symphysis ◽  
Pelvic Fractures ◽  
Urethral Injury ◽  
Pelvic Ring Fractures ◽  
Vaginal Injury

Abstract Backgound: Pelvic ring fractures associated with vaginal injuries were rarely reported due to low incidence. The displaced segments of pelvic ring may increase the risk of vaginal injury. The aim of this retrospective study was to evaluate the correlation between pelvic fracture and vaginal injury. Methods: We conducted a retrospective review of 25 patients with pelvic fractures associated with vaginal injury treated at our institution. The medical records of these patients were collected and 24 patients were followed-up for 10-36 months. Results: All patients suffered anterior pelvic ring fracture. Young-Burgess fracture classification and compromised pubic symphysis were related to severity vaginal injury. Gauze packing was done in 6 patients and 18 patients received surgical repair. Infection occurred in 6 patients among them 4 were due to delayed diagnosis. Factors associated with pelvic outcome were age, urethral injury, and infection. Four patients suffered pain in sexual intercourse but no influence factor found correlated to sexual function. Conclusion: VS type pelvic fractures and compromised pubic symphysis are related to higher severity of vaginal injury. Disruption of anterior ring and an unstable pelvic ring caused by forces on coronary and axial plane may increase the risk of vaginal injury. Key words: Pelvic fracture, Vaginal injury, Clinical outcome

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