Locked pubic symphysis into the obturator foramen: a rare case presentation and literature review

Percutaneous Treatment of Locked Pubic Symphysis with the Anterior Subcutaneous Pelvic Fixator (INFIX): A Case Report

CASE

A 54-year-old woman was involved in a motor vehicle collision and sustained a lateral compression type 1 pelvic ring fracture with pubic symphyseal dislocation or a "locked pubic symphysis." Her injury failed to reduce with closed reduction maneuvers under anesthesia and necessitated a percutaneous reduction using a distraction force applied through supra-acetabular placed pedicle screws. This anterior subcutaneous internal pelvic fixator (INFIX) was also used to stabilize the injury.

CONCLUSION

This is the first reported case where a locked pubic symphysis, which failed standard closed reduction measures, was reduced and stabilized through a percutaneous technique, using the INFIX.

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

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.

Case Report on Locked Pubic Symphysis with Concomitant Ipsilateral Acetabular Fracture

Background

Locked pubic symphysis or overlapping symphysis is a rare injury which happens when a pubic bone displaces behind the contra lateral pubic rami. It usually arises from lateral compression injuries. In this case report, we try to share our experience on the operative fixation of locked pubic symphysis and concomitant ipsilateral acetabular fracture.

Case Presentation

A 24-year-old male patient presented after a road traffic accident with lateral compression injury to the pelvis. He was found to have locked pubic symphysis, right side transverse acetabular, and right side closed tibial fracture. He was taken to the operation theater 10 days later after he was managed for the additional chest contusion he had. Successful open reduction and plate fixation of the overlapped symphysis and percutaneous screw fixation of the ipsilateral acetabulum were done at the same time. An intramedullary nail was inserted for the tibial fracture.

Conclusion

Locked symphysis is a rare trauma and even more complex when associated with acetabular fracture. Both situations may happen at the same time and could be managed operatively.

Treatment of Locked Pubic Symphysis by Distraction Osteotomy of the Superior Pubic Ramus: A Case Report

CASE

An 18-year-old adolescent sustained a lateral compression injury to the pelvis that featured a locked pubic symphysis with plastic deformation of the sacrum. The pubic bone was entrapped in the opposite obturator foramen and required a novel distraction osteotomy of the superior ramus to restore the symphysis. The patient developed a urethral stricture 3 months after injury that required urethroplasty. The symphysis remained in alignment without any morbidity at the osteotomy site over 13 months of follow-up.

CONCLUSION

Locked pubic symphysis is frequently associated with urethral injuries. The distraction osteotomy of the superior pubic ramus described is a viable reduction maneuver that neutralizes the plastic deformation forces.

Locked book pubic symphysis: A case report in a resource-limited setting in sub-Sahara Africa

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Locked pubic symphysis is a serious injury of the pelvis.

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Very few cases has been reported in the literature.

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This nosological entity shows peculiarities in its manually difficult reduction and associated complications.

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A good outcome can be obtained after management with simple gestures, possible even in ressource-limited settings.

Introduction

Locked pubic symphysis is a rare but serious injury that occurs by lateral compression mechanism. It is an overlapping pubic symphysis dislocation, with one pubic bone entrapped behind the contralateral pubis, locked into the contralateral obturator foramen.

Case report

We report the case of a 25 years old male who presented with acute urine retention following a left lateral compression pelvic trauma by a motor vehicle and was diagnosed with a locked pubic symphysis treated successfully by open reduction and combined internal and external fixation.

Conclusion

Locked pelvic symphysis is a rare form of pelvic injury. The majority of cases require stabilization by open reduction and internal fixation of the anterior pelvic ring. Urogenital injuries are the commonest associated injuries, despite unfavourable mechanism.

Overlapping Dislocation of the Pubic Symphysis with an Open Reduction and Anterior and Posterior Pelvic Ring Fixation: A Case Report

CASE

We present a case of a patient who sustained overlapping dislocation of the pubic symphysis (ODPS), which required an open reduction as well as anterior and posterior pelvic ring fixation.

CONCLUSION

This case report is a valuable addition to the current literature on ODPS because we believe it to be the first report describing a patient who required both anterior and posterior fixation because of pelvic instability.