Symphyseal plate with trans-symphyseal cross-screws for fixation of tile-type B1 pelvic ring injuries: radiological and
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ORIGINAL PAPER
Symphyseal plate with trans-symphyseal cross-screws for fixation of tile-type B1 pelvic ring injuries: radiological and functional evaluation Fady Kamal Beder 1 & Mohamed Salama Hamdy 1 & Ihab Ibraheem El-Desouky 1 & Khaled Fawzy Abdelkader 1 & Ahmed Hazem Abdelazeem 1 Received: 19 July 2020 / Accepted: 9 October 2020 # SICOT aisbl 2020
Abstract Introduction Failure to neutralize the different physiological forces acting on the inferior as well as the superior regions of the pubic symphysis, the long healing time, is blamed for the repeated failures of conventional superior symphyseal plating. Material and methods A three years prospective case series study between January 2017 and December 2019 was done, to evaluate the radiological and the functional outcomes, using Matta/Tornetta and Majeed criteria respectively, of the combination of trans-symphyseal cross-screws configuration and superior symphyseal plate in Tile-type B1 pelvic injuries. Results Thirty patients, 18 with anteroposterior compression type II and 12 with type III, with a mean follow-up of 20 months ±5 were included. Radiologically, 26 (86.6%) cases showed an excellent, one (3.3%) good and three (10%) fair outcome. Clinically, excellent outcome in 26 (86.6%) cases, good in two (6.6%) cases, and fair in two (6.6%). Intra-operative drill bit breakage occurred in three (10%) cases and was the only reported technical complication. Significant re-displacement was reported in three (10%) cases. Conclusion The open trans-symphyseal cross-screws for fixation of the superior symphyseal plate is a simple, efficient, and safe technique with the biomechanical advantages of an extra-fixation point to the inferior symphysis together with a long and a strong bony anchorage. Keywords Pubic symphysis diastasis . Anteroposterior pelvic compression injuries . Rotational unstable . Tile B1 . Pelvic fracture . Fractured pelvis . Symphyseal disruption
Introduction Tile-type B1 “open book” external rotation injuries account for 15–20% of pelvic fractures. The anteroposterior pelvic compression (APC) force leads to diastasis of the symphysis pubis anteriorly with or without injury of the sacroiliac joint or fracture of the iliac bone posteriorly [1, 2]. Symphyseal diastasis exceeding 25 mm is considered an absolute indication for surgical stabilization of this unstable condition [3]. Up-to-date, open reduction, and plate fixation of the * Ahmed Hazem Abdelazeem [email protected] 1
Pelvic Trauma and Arthroplasty Unit, Department of Orthopaedics and Traumatology, Kasr-Alainy Hospital, Cairo University, Cairo, Egypt
symphysis pubis along with fixation of the posterior injury are considered “the standard of care” [1–5]. However, the failure of symphyseal plating is still a great matter of concern reported in 12–75% of patients with reported revision rates between 3 and 30%. The stresses, which cause the failure of the construct, include traction, compression, and shearing. These stresses affect both the superior and inferior parts of the symphysis in
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