OBJECTIVE: To review the research progress of pubic symphysis diastasis and provide effective reference for orthopedic surgeons in the diagnosis and treatment of pubic symphysis diastasis. METHODS: The anatomy, injury mechanism, treatment, and other aspects of pubic symphysis diastasis were summarized and analyzed by reviewing the relevant research literature at domestically and internationally in recent years. RESULTS: The incidence of pubic symphysis diastasis is high in pelvic fractures, which is caused by the injury of the ligaments and fibrocartilage disc around the pubic symphysis by external force. The treatment plan should be individualized according to the pelvic stability and the needs of patients, aiming to restore the stability and integrity of the pelvis and improve the quality of life of patients after surgery. CONCLUSION At present, the research on pubic symphysis diastasis still needs to be improved. In the future, high-quality, multi-center, and large-sample studies are of great significance for the selection of treatment methods and the evaluation of effectiveness for patients with pubic symphysis diastasis.
Female ; Humans ; Pubic Symphysis Diastasis/etiology* ; Quality of Life ; Pubic Symphysis/injuries* ; Pelvis/surgery* ; Fractures, Bone/surgery*

A locked pubic ramus body is an unusual variant of lateral compression injury. Till date, there have been only 25 cases reported in the published literature. We herein described a case where the right pubic ramus was entrapped within the opposite obturator foramen with an overlap of greater than 4 cm, with associated urethral injury. When all maneuvers of closed and instrumented 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. The patient underwent delayed urethral repair 10 weeks after the index surgery. At 3-year follow-up, the patient has sexual dysfunction especially difficulty in maintaining erection, secondary urethral stricture, heterotopic ossification, and breakage of implants.
Humans ; Pubic Bone/injuries* ; Follow-Up Studies ; Osteotomy, Sagittal Split Ramus ; Pelvis ; Urethra/surgery* ; Pubic Symphysis/injuries*

OBJECTIVETo observe the effect of pubic fractures reducted and fixed thorough the punctiform incision approach.

METHODSFrom 2002 to 2005, 10 cases with 18 fractures of pubis rami (8 male and 2 female) were treated with inserting construction plate by the punctiform incision approach. The average age of these patients was 37.2 years (range, 24 to 56 years). The mean duration between injury and operation was 8.7 days (range, 4 to 14 days).

RESULTSInternal fixation for eighteen pubis fractures were accomplished by 28 punctiform incisions. The blood loss for each incision was averagely 30 ml, operation time of each pubic was about 45 minutes. Function restoration was evaluated by Majeed' score and all patients gained excellent result.

CONCLUSIONThe fracture of pubic rami can be fixed sucessfully by punctiform incision approach. It provides smaller incision, less postoperative complications and excellent function rehabilitation.

Adult ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Fracture Healing ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Pubic Bone ; surgery

Adult ; Bone Plates ; Female ; Humans ; Male ; Middle Aged ; Pubic Symphysis Diastasis ; surgery

OBJECTIVETo investigate the feasibility and effectiveness of modified Stoppa approach in treatment of bilateral pubic fractures of pelvic.

METHODSThe therapeutic effects of 16 patients with bilateral pubic fractures treated through the modified Stoppa approach from January 2010 to January 2014 were summarized and analyzed, involved 11 males and 5 females with an average age of 40.5 years old ranging from 17 to 59 years. According to Tile classification, there were 8 patients with type A, 6 with type B and 2 with type C. For 16 pelvic fractures, the modified Stoppa approach was used exclusively 11 cases, in combination with the iliac fossa approach in 4 cases, and in combination with the posterior approach in 1 case. The operation incision length, operation time , intra-operative blood loss and postoperative complications were observed. The fracture reduction and post-operative function were assessed by Matta criteria and Majeed system respectively.

RESULTSThe incision length of the modified Stoppa approach ranged from 8 to 10 cm (averaged in 9 cm). The operation time ranged from 75 to 135 minutes (averaged in 95 minutes). The intra-operative blood loss ranged from 400 to 900 ml (averaged in 600 ml). Sixteen patients were followed up from 7 to 18 months (averaged in 12.5 months). The fractures were all healed, the fracture healing time was 2.7 to 5 months (means 3.1 months). There were no infections, ectopic ossification, screw loosening, plate breakage and lateral ventral syndrome. According to Matta criteria for pubic fracture reduction, the result was excellent in 9 cases, good in 6, fair in 1. The Majeed function scores at 6 months after operation was 85.32±8.50; the result was excellent in 8 cases, good in 6 cases, fair in 2 cases.

CONCLUSIONThe modified Stoppa approach has characteristics of convenience and directness of incisions, clear operation field, easy reduction, few complications and fast recovery , it is an ideal choice in surgical treatment of bilateral pubic fractures.

Adolescent ; Adult ; Bone Plates ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Operative Time ; Orthopedics ; methods ; Pubic Bone ; injuries ; surgery ; Young Adult

OBJECTIVETo evaluate the reliability of limited open reduction and minimally invasive plate osteosynthesis (MIPO) for injuries of pelvic anterior ring and to explore its operative techniques and therapeutic efficacy.

METHODSFrom March 2009 to March 2012,20 patients with injuries of pelvic anterior ring were surgically fixed with reconstructive plates through minimally invasive ilioinguinal approach. There were 13 males and 7 females with an average age of 41.6 years ranging from 25 to 61 years. According to classification of Tile, there were 5 cases of type A2, 2 cases of type B1, 9 cases of type B2, 1 case of type B3, 3 cases of type C1. Including 15 cases with anterior ring fracture, 2 cases with anterior ring fracture combined with pubic symphysis separation, and 3 cases with anterior and posterior fractures. Operation time, intra-operative blood losing, injuries of femoral nerve and iliac blood vessels, condition of fracture reduction were observed.

RESULTSAll wounds healed at one stage. No complications such as infection or deep venous thrombosis occurred. According to Matta criterion of fracture reduction, 12 cases got excellent results, 7 good, 1 fair. Eighteen patients were followed up from 6 to 32 months with a mean of 16.3 months. According to functional score of Majeed, 15 cases obtained excellent results and 3 good,with an average score of 94.3 +/- 6.0.

CONCLUSIONThe modified ilioinguinal approach has advantage of short operation time, less blood losing,minimally invasive in treating injuries of pelvic anterior ring and can obtain satisfactory outcomes.

Adult ; Bone Plates ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; surgery ; Pubic Symphysis Diastasis ; surgery ; Treatment Outcome

Although fatigue fractures are not unusual in athletes and military personnel those of the pubic ramus are rare. We report three cases of fatigue fractures of the inferior pubic rami in two male recruits and one female military cadet. On the initial radiograph, most of the lesions were subtle and easy to overlook. However, bone scintigraphy provided more distinct images that allowed easy and early detection of lesions, and MR imaging presented more diagnostic information, which allowed a precise diagnosis.
Adult ; Female ; Fractures, Stress/*diagnosis/radiography/radionuclide imaging/surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Military Personnel ; Pubic Bone/*injuries

OBJECTIVE: For patients who had hemipelvectomies involving the resection of a portion or the whole of the pubis, bony reconstruction was not recommended commonly. However, the soft tissue reconstruction of the lower abdominal wall may benefit these patients. The object of the study was to determine the clinical effect of lower abdominal wall reconstruction with LARS ligament after pubic tumor resection interms of patient-reported and objective outcome. METHODS: In this series, we reviewed twenty-five patients who underwent pubic tumor resection followed by reconstruction with LARS ligament between February 2012 and February 2018 retrospectively. We evaluated the clinical outcome and complication of this surgical treatment. The function outcome was evaluated according the musculoskeletal tumor society scores (MSTS) for all the patients at the end of the last follow-up. RESULTS: All the patients were stable during the surgery. There were eight patients who underwent resection of superior ramus of pubis, five patients who had resection of inferior ramus of pubis, and twelve patients who received both superior and inferior ramus of pubis. For all the patients, the mean blood loss was (774±580) mL. The mean operation time was (138±25) min. The mean hospital stay was (19±6) d. For the patients who had resection of superior ramus, inferior ramus, as well as both superior and inferior ramus, the mean blood loss were (763±802) mL, (730±315) mL and (808±485) mL, respectively. The mean operation time were (133±27) min, (135±35) min and (143±20) min, respectively. The mean hospital stay were (18±5) d, (22±9) d and (19±6) d, respectively. The mean follow-up time was (37±21) months. Local recurrence was observed in one patient with chondrosarcoma. One patient with renal cancer metastasis died of the disease. No ligament infection, ligament related complication and incisional hernias were observed. Twenty-three patients could ambulate without assistive devices, and the remaining two could walk by crutches. Postoperative pain was reported as none in nineteen patients, mild in three, and moderate in three. From a functional point, the mean MSTS score was 87±4. CONCLUSION Lower abdominal wall reconstruction with LARS ligament after pubic tumor resection could have satisfactory clinical outcome. It could prevent the occurrence of herniation, decrease the infection rate by minishing the dead space, and achieve good patient-reported outcome.
Abdominal Wall ; Humans ; Ligaments ; Neoplasm Recurrence, Local ; Prostheses and Implants ; Pubic Bone/surgery* ; Reconstructive Surgical Procedures ; Retrospective Studies ; Treatment Outcome

With rapid advancement in surgical techniques and improvement in implant materials, rate of internal fixation for pubic symphyseal disruption in rotationally and vertically unstable pelvic ring injuries has increased. Among various modes of implant failure, screw/plate breakage and loosening are common complications following unstable fixation. Migration of loose screws into the urinary bladder has been reported as an extremely uncommon complication of pubic symphyseal plating. Here we present a case report of a 52-year-old female who presented with asymptomatic passage of screws in her urine following migration into the bladder, 2 years after symphyseal plating for pubic diastasis in an anteroposterior compression pelvic ring injury.
Accidents, Traffic ; Bone Plates ; Bone Screws ; adverse effects ; Female ; Foreign-Body Migration ; diagnosis ; Humans ; Metals ; Middle Aged ; Pubic Symphysis Diastasis ; etiology ; surgery ; Urination

Adult ; Aged ; Bone Screws ; Female ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; surgery ; Pubic Symphysis Diastasis ; surgery ; Treatment Outcome ; Young Adult