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Abstract
BackgroundThe aim of the study was to introduce a new percutaneous technique for the treatment of traumatic pubic symphysis diastasis using a TightRope and external fixator. A comparison between this technique and percutaneous fixation using a cannulated screw was performed.MethodsFrom January 2009 to December 2013, 26 patients with type II traumatic pubic symphysis diastasis were treated at two level 1 regional trauma centers. Among them, 10 patients were treated with a percutaneous TightRope and external fixator and 16 patients were treated with percutaneous cannulated screw fixation. Functional outcomes were evaluated using the Majeed scoring system. Patient satisfaction was evaluated using the modified visual analog scale. Radiological results were assessed based on the width of pubic symphysis preoperatively, immediately postoperatively, and at the final follow-up. Postoperative complications were also recorded.ResultsThere were no significant differences between the groups in Majeed scores and patient satisfaction (p > 0.05). There were no significant differences in the width of pubic symphysis preoperatively, immediately postoperatively, and at the final follow-up (p > 0.05). No significant differences were found regarding infection, fixation failure, or the need for revision surgery (p > 0.05).ConclusionsThe new percutaneous technique using a TightRope and external fixator is a successful alternative for the treatment of type II traumatic pubic symphysis diastasis, which results in similar outcomes comparing to percutaneous cannulated screw fixation.
Highlights
The aim of the study was to introduce a new percutaneous technique for the treatment of traumatic pubic symphysis diastasis using a TightRope and external fixator
The new percutaneous technique using a TightRope and external fixator is a successful alternative for the treatment of type II traumatic pubic symphysis diastasis, which results in similar outcomes comparing to percutaneous cannulated screw fixation
Pubic symphysis diastasis (PSD) was excluded because the injury is often treated conservatively; an anterior-posterior compression (APC)-III injury was excluded because combined posterior fixation is needed; patients who had lateral compression, vertical shear or combined mechanism fractures, open fractures, combined acetabular fractures, or pubic rami fractures were excluded; patients who had immature skeletons or medical contraindications, such as combined neurovascular injuries or diabetes, were excluded
Summary
The aim of the study was to introduce a new percutaneous technique for the treatment of traumatic pubic symphysis diastasis using a TightRope and external fixator. A comparison between this technique and percutaneous fixation using a cannulated screw was performed. Pubic symphysis diastasis (PSD) is typically associated with a high-energy mechanism of injury [1]. Many treatments have been reported on restoration of the anatomy of pubic symphysis, the appropriate strategy remains controversial [2, 3]. The technique needs extensive exposure of the pubic symphysis, resulting in more complications, such as blood loss, neural and vascular injuries, wound problems, and heterotopic bone formation [9,10,11]. The physiological movement across the pubic symphysis often leads to fixation failure [12]
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