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*

Peripartum pubic symphysis separation is a recognized complication of delivery with incidence ranging 1:300 to 1:30,0002,4-6. The underlying etiology of symptomatic symphyseal separation has not fully elucidated. Diagnosis is mostly based on clinical findings. Complete recovery was made only by analgesics and physical therapy. The occurrence of symphyseal separation does not necessitate an alteration in the management of subsequent pregnancy7. We have experienced a case of disruption of symphysis pubis during labor supposed to be caused by too rapid labor course. Details regarding this case and a review of the literature are presented.
Analgesics ; Diagnosis ; Incidence ; Peripartum Period ; Pregnancy ; Pubic Symphysis

PURPOSE: To acquire anatomical data for the normal pelvic bone structure using three-dimensional computed tomography (3D CT) and to propose the most appropriate angle and screw length for safe screw insertion during symphysis pubis plating. MATERIALS AND METHODS: We performed 3D CT analysis in 52 patients who required plating and selected a medial and lateral insertion point between the symphysis pubis and the pubic tubercle. Using a three-dimensional medical image analysis program, we evaluated the appropriate screw length, sagittal angle, and oblique angle at each point in this cohort. RESULTS: At the medial point, the sagittal angle was determined to be 49.1degrees with an average screw length of 49.4 mm. At the lateral point, we calculated an average screw length of 49.1 mm, oblique angle of 23.2degrees, and sagittal angle of 45.7degrees. The screw length was longer in men than in women (4.6 mm and 7.3 mm, respectively) at the medial and lateral point. CONCLUSION: At the symphysis pubis diastasis, we can insert the screw caudally at 49degrees with a minimal length of 37 mm at the medial point. We can insert the screw caudally at 46degrees, medially at 23degrees, with a minimal 34 mm length at the lateral point.
Female ; Humans ; Male ; Pelvic Bones ; Pelvis ; Pubic Symphysis Diastasis

We report a case of pubic symphysis diastasis, which was initially asymptomatic; however, it became symptomatic with urinary incontinence during pregnancy. The patient was treated with open reduction and internal fixation of the symphysis pubis. A corticocancellous autograft was used for filling the gap which remained despite bilateral compression of the iliac bones. We obtained satisfactory outcome in terms of symptoms at the 3 years' follow-up; however, there was instability findings in the X-rays with broken screws. We conclude that asymptomatic pubic symphysis diastasis might be symptomatic after additional trauma (such as pregnancy) in the following days, if it was unstable in the very beginning of injury. Fixation of old pubic symphysis diastasis with reconstruction plate by filling the gap by using corticocancellous autograft, might not prevent ultimate implant failure if the symphysis pubis diastasis is part of an unstable pelvic fracture in the very beginning.
Autografts ; Follow-Up Studies ; Humans ; Pelvis ; Pregnancy ; Pubic Bone ; Pubic Symphysis Diastasis* ; Transplants* ; Urinary Incontinence

The pelvic ring is stressed by external forces: by partial body weight, by ligament tension, and by muscles forces stabilizing the hip joints. For the symphysis ossis pubis there exist data concerning the type and magnitude of stresses. In one-leg-standing pressure, shear forces are predominant, and in both-leg-standing tensile forces are acting on the pelvic ring. Rupture of the symphysis is problematic due to the variety of its movements. Most literature descriptions of stress in the symphysis reflect only the frontal plane. Our intention was to make morphological as well as experimental investigations on the symphysis ossis pubis to delineate how it will be stressed in the horizontal plane. Twenty pubic bones taken from embalmed adult human cadavers (12 male, 8 female) were used. Horizontal and frontal slices (3 mm thick) of the symphyseal part of the os pubis were made. X-rays and densitometric analysis were performed. The width of the symphysis cartilage in the dorsal and the ventral regions was measured on 15 whole skeleton specimens coming from adult human cadavers. For experimental study an embalmed pelvic ring which had no abnormality was used. The symphysis pubis was cut completely in the midsagittal plane and then the ring was stressed via the cranial sacrum. Our results demonstrate that the symphysis is stressed by bending in the horizontal plane in one-leg-standing. In both-leg-standing the symphysis is stressed by tensile forces.
Adult ; Body Weight ; Cadaver ; Cartilage ; Hip Joint ; Humans ; Intention ; Ligaments ; Male ; Muscles ; Pubic Bone ; Pubic Symphysis* ; Rupture ; Sacrum ; Skeleton

OBJECTIVE: To explore application value of ultrasound in treating postpartum pubis symphysis diastasis by bone setting manipulation. METHODS: Retrospective analysis was performed on 30 patients (case group) with postpartum pubis symphysis diastasis diagnosed in Wangjing Hospital, China Academy of Chinese Medical Sciences from June 2017 to January 2021, aged from 21 to 43 years old, with an average of (33.0±3.5) years old. The main clinical manifestations were mobility disorders such as turning over and walking, and all patients were treated by bone setting manipulation. Before and after treatment, pain and degree of pubic symphysis separation were evaluated by visual analogue scale(VAS) and ultrasonography. In normal group, 30 menopausal women aged from 49 to 59 years old with an average of(54.0±2.9) years old who wanted to remove intra uterine device(IUD) and were underwent conventional pelvic plain radiographswere selected, and the width of pubic symphysis space was measured by ultrasound and plain radiographs. RESULTS: In normal group, the width of pubic symphysis was about (5.2±1.7) mm by ultrasonography, X-ray measurement was (5.0±2.1) mm, and showed no difference(P>0.05).In case group, the width of pubic symphysis measured by ultrasound before manipulation was about (9.5±1.8) mm, VAS was 6.05(5.27, 6.80) scores;while the width of pubic symphysis measured by ultrasound before manipulation was about (5.8±1.3) mm, VAS was 0(0, 0) scores, and there were statistical difference before and after manipulation (P<0.05). CONCLUSION Ultrasound is examation method with safe, non radioactive, easy to repeat for many times, could clearly show cartilage, ligament and bone structure around pubic symphysis, and is more suitable for the imaging diagnosis of postpartum pubis symphysis diastasis, which provide quantitative imaging basis for clinical evaluation of the curative effect of bone setting manipulation in treating postpartum pubis symphysis diastasis.
Adult ; Female ; Humans ; Middle Aged ; Postpartum Period ; Pubic Bone ; Pubic Symphysis Diastasis/therapy* ; Retrospective Studies ; Ultrasonography ; Young Adult

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*

Hypermobility of the bladder neck in response to increased intraabdominal pressure is the anatomical cause of female stress urinary incontinence ( SUI) and the degree of bladder neck movement has been used to classify SUI patients and to guide management decisions. We performed transvaginal ultrasonography in 14 SUI patients and 20 normal female as control to assess its role on the demonstration of the anatomical features associated with SUI. We adopted three anatomical factors in the sagittal plane which affect the bladder neck mobility , vertical (JY) and horizontal(JX) distance difference between pubic symphysis and bladder neck, and rotation angle difference(JZ) composed of by pubic symphysis and bladder neck during rest and stress states. There were significant differences in Y and Z between the two groups. Three months after corrective surgery for SUI these two factors showed significant improvement in all patients. It could be concluded that transvaginal ultrasonography is a safe and reliable method to diagnosis and evaluate the postoperative outcome for SUI.
Diagnosis ; Female ; Humans ; Neck ; Pubic Symphysis ; Ultrasonography* ; Urinary Bladder ; Urinary Incontinence*

For identification of the risk factors for lower urinary tract injuries in patients with pelvic fractures, we reviewed the records of 332 patients with pelvic fractures and 60 patients with urethral or bladder ruptures not associated with pelvic fractures seen at our hospital during recent 5 years. The incidence of lower urinary tract injuries in patients with pelvic fractures was 9.9 per cent (urethra 57.6 per cent, bladder 36.4 per cent. and both 6.0 per cent).Of the 181 simple rami fractures 21 (11.6 percent) had lower urinary tract injuries. Of the 90 rami fractures combining other fractures 11 (12.2 per cent} had lower urinary tract injuries, especially 5 (50.0 per cent) of the 10 combining symphysis pubis diastasis. Of the 14 bladder ruptures 13 had gross hematuria, and of the 21 urethral ruptures all had blood at urethral meatus. For evaluation of significance of hematuria as a indicator for bladder ruptures, we reviewed 257 pelvic fractures without urethral ruptures and upper tract injuries. While of the 25 cases with gross hematuria 13 (52.0 percent) had bladder ruptures, of the 76 cases with only microscopic hematuria 1 case had bladder rupture. We conclude that the high risk factors for lower urinary tract injuries in patients with pelvic fractures are both rami fracture, dispacement of hemipelvis, and symphysis pubis diastasis. Therefore prompt diagnostic procedures for urethral and bladder ruptures must be performed in those cases, especially when combined with gross hematuria or blood at urethral meatus.
Hematuria ; Humans ; Incidence ; Pubic Symphysis Diastasis ; Risk Factors* ; Rupture ; Urinary Bladder ; Urinary Tract*

PURPOSE: To investigate the significance of slowly rising abdominal pressure (SRAP), which is often observed in nonneurogenic children during bladder filling in video urodynamic studies (VUDSs). METHODS: The records of patients who underwent VUDS from July 2011 to June 2013 were reviewed. SRAP was defined as a rising curve over 5 cm H2O from the baseline abdominal pressure during the filling phase in VUDS. Bladder descent was defined when the base of the bladder was below the upper line of the pubic symphysis. An open bladder neck was defined as the opening of the bladder neck during the filling phase. RESULTS: Of the 488 patients, 285 were male patients. The mean age at VUDS was 3.7 years (range, 0.2-17.6 years). The VUDS findings were as follows: SRAP, 20.7% (101 of 488); descending bladder, 14.8% (72 of 488); and bladder neck opening, 4.3% (21 of 488). Of the 72 patients with a descending bladder, 84.7% had SRAP. A significant difference in the presence of SRAP was found between the descending bladder and the normal bladder (P<0.001). Of the 101 patients with SRAP, 40 (39.6%) did not have a descending bladder. Of the 40 patients, 14 (35.0%) had a bladder neck opening, which was a high incidence compared with the 4.3% in all subjects (P<0.001). CONCLUSIONS: SRAP was associated with a descending bladder or a bladder neck opening, suggesting that SRAP is a compensatory response to urinary incontinence. SRAP may also predict decreased function of the bladder neck or pelvic floor muscle.
Child* ; Humans ; Incidence ; Male ; Neck* ; Pelvic Floor* ; Pubic Symphysis ; Urinary Bladder* ; Urinary Incontinence ; Urodynamics*