Abstract
BackgroundFailure of fixation (FF) in pubic symphysis diastasis (SD) ranges between 12 and 75%, though whether it influences functional outcomes is still debated. The objective of this study is to evaluate the impact of anterior pelvic plate failure and loss of reduction on Majeed’s functional scores.MethodsSingle center retrospective review of consecutive patients with acute SD treated by means of anterior pubic plating. Thirty-seven patients with a mean age 45.7 ± 14.4 years were included. Demographics, AO classification, pelvic fixation and secondary procedures were recorded. Majeed’s functional scores at minimum 6 months follow-up were compared according to the presence of FF and loss of reduction.ResultsFifteen patients presented FF. Eight presented an additional loss of symphyseal reduction. Mean Majeed´s score (MMS) in patients with and without FF was 64.4 ± 13.04 and 81.8 ± 15.65, respectively (p = 0.0012). Differences in MMS in patients without FF and those with FF and maintained or loss of anterior reduction were 11.3 [70.5 vs 81.8] (p = 0.092) and 22.7 [59.1 vs 81.8] (p = 0.001), respectively. Significant association of FF with AO classification was noted. (OR 12.6; p = 0.002).ConclusionsDifferences in MMS in the analyzed groups suggest that loss of reduction might be more relevant than failure of the anterior osteosynthesis in functional outcomes.
Highlights
The pubic symphysis is a fibrocartilaginous joint composed of four strong ligaments that allows discrete multidirectional movement [1]
The objective of this study is to evaluate the impact of anterior pelvic plate failure and loss of reduction on early Majeed’s functional scores
Additional loss of symphyseal reduction was defined as an increase ≥ 5 mm in the distance between pubic bones in radiological follow up
Summary
The pubic symphysis is a fibrocartilaginous joint composed of four strong ligaments that allows discrete multidirectional movement [1]. High energy mechanisms are required to injure these ligaments, and damage to surrounding structures can result in relatively high rates of hemodynamic instability and mortality in the acute setting [2,3,4,5]. As ligamentous structures heal and normal joint motion resumes, rigid fixation methods can result in metalwork loosening, plate breakage or loss of anatomic reduction. Failure rates of pubic plates ranging from 12 to 75% and significant loss of symphyseal reduction in 7 to 88% have been previously reported [11,12,13,14,15]. Failure of fixation (FF) in pubic symphysis diastasis (SD) ranges between 12 and 75%, though whether it influences functional outcomes is still debated. The objective of this study is to evaluate the impact of anterior pelvic plate failure and loss of reduction on Majeed’s functional scores
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