Abstract
ObjectiveInstability of the pubic symphysis often results in a poor outcome and reduced mobility of the patient. In some cases, an arthrodesis of the pubic symphysis is required. Until today, there is no data published how many of these procedures are performed annually and there is also no data about the outcome after this extensive surgery.MethodsWe developed a novel surgical technique to address the arthrodesis of the pubic symphysis in a minimally invasive approach. Therefore, we used for this purpose modified instruments and performed the transplantation of a cylindrical bone substitute into the pubic symphysis, without an extensive approach or dissecting the anterior or posterior symphyseal ligaments.ResultsUsing this novel technique, a minimally invasive symphysiodesis was achieved in radiological findings, after the procedure.ConclusionThus, this actually minimally invasive surgical technique seems to be a promising advancement for the arthrodesis of the pubic symphysis.
Highlights
Chronic anterior pelvic ring instability has been associated with chronic pain and often results in poor patient outcome [1].The instability of the pubic symphysis often occurs posttraumatically, for example after a symphyseal rupture, related to pelvic ring injuries [1,2,3]
Existing instruments were modified in order to be in a position to perform a minimally-invasive symphysiodesis using a cylindrical bone substitute on a human specimen without further dissecting the stabilizing anterior or posterior symphyseal ligaments
Chronic instability of the pubic symphysis may result from inadequate posttraumatic healing of the symphyseal ligaments, degenerative changes due to chronic sportive overuse and adductor tendon injuries [4], osteitis pubis [10] or post-partum because of hormonal misbalance [8, 9]
Summary
Chronic anterior pelvic ring instability has been associated with chronic pain and often results in poor patient outcome [1].The instability of the pubic symphysis often occurs posttraumatically, for example after a symphyseal rupture, related to pelvic ring injuries [1,2,3]. Osteitis pubis resulting from rheumatologic disorders and puerperal symphyseal rupture after delivery have been reported within 1 in 300 to 1:30000 cases [1, 5,6,7] The treatment of these patients often is challenging and implant failure after plate stabilization is well described in. Existing instruments were modified in order to be in a position to perform a minimally-invasive symphysiodesis using a cylindrical bone substitute on a human specimen without further dissecting the stabilizing anterior or posterior symphyseal ligaments. To our knowledge, this is the first attempt to address symphyseal instability using a pressfit cylindrical bone substitute for arthrodesis. We presume that chronic instability of the pubic symphysis can be reliably treated using this minimally invasive technique in addition to our published minimally invasive stabilization technique of the pubic symphysis using an internal fixator [2] or even without osteosynthesis for stabilization
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