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

OBJECTIVEThe treatment of subtrochanteric fractures is challenging and treatment modalities and implants are constantly evolving. This study attempts to revisit and compare extramedullary vs. intramedullary devices in relatively young population.

METHODSThirty patients with subtrochanteric fractures were enrolled and treated with extramedullary or intramedullary devices and follow-up continued one year for clinico-radiological assessment.

RESULTSThe mean age of patients was 37.53 years. Most were males between 21-40 years. The dominant mode of injury was traffic accidents (66%). Fractures were classified according to Russell-Taylor classification. Forty percent were Russell-Taylor type IA, 37% type IB and 23% type IIA. Average time to surgery was 3.6 days from the time of admission to hospital. Mean duration of surgery was 45 minutes for intramedullary device (group A) and 105 minutes for extramedullary device (group B). Average blood loss was 100 ml in group A and 200 ml in group B. Mean duration of radiation exposure was 130 seconds and 140 seconds for groups A and B, while average duration of hospital stay was 12 days and 16 days respectively. Excellent results were seen in 47% of cases in group A and 33% of cases in group B.

CONCLUSIONIntramedullary device is a reliable implant for subtrochanteric fractures. It has high rates of union with minimal soft-tissue damage. Intramedullary fixation has biological and biomechanical advantages, but surgery is technically demanding. Gradual learning and patience is needed to make this method truly rewarding.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Fracture Fixation, Intramedullary ; instrumentation ; Hip Fractures ; surgery ; Humans ; Male ; Tertiary Care Centers ; Treatment Outcome