Can locking plate fixation of symphyseal disruptions allow early weight bearing?

Kankanalu, Pradeep; Orfanos, Georgios; Dwyer, Jonathan; Lim, Justin; Youssef, Bishoy

doi:10.1016/j.injury.2020.02.094

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…Posterior fixation has been proposed as a method of augmentation in fractures with some component of posterior ligamentous injury in order to reduce anterior implant failure [26]. Currently, B3 fractures and C type fractures are managed with posterior fixation, most frequently using sacroiliac screws, though failure rates remain high [3,4,15,27,28].…”

Section: Discussionmentioning

confidence: 99%

Fixation failure in patients with traumatic diastasis of pubic symphysis: impact of loss of reduction on early functional outcomes

2021

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Background Failure of fixation (FF) in pubic symphysis diastasis (SD) ranges between 12 and 75%, though whether it influences functional outcomes is still debated. The objective of this study is to evaluate the impact of anterior pelvic plate failure and loss of reduction on Majeed’s functional scores. Methods Single center retrospective review of consecutive patients with acute SD treated by means of anterior pubic plating. Thirty-seven patients with a mean age 45.7 ± 14.4 years were included. Demographics, AO classification, pelvic fixation and secondary procedures were recorded. Majeed’s functional scores at minimum 6 months follow-up were compared according to the presence of FF and loss of reduction. Results Fifteen patients presented FF. Eight presented an additional loss of symphyseal reduction. Mean Majeed´s score (MMS) in patients with and without FF was 64.4 ± 13.04 and 81.8 ± 15.65, respectively (p = 0.0012). Differences in MMS in patients without FF and those with FF and maintained or loss of anterior reduction were 11.3 [70.5 vs 81.8] (p = 0.092) and 22.7 [59.1 vs 81.8] (p = 0.001), respectively. Significant association of FF with AO classification was noted. (OR 12.6; p = 0.002). Conclusions Differences in MMS in the analyzed groups suggest that loss of reduction might be more relevant than failure of the anterior osteosynthesis in functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Fixation failure in patients with traumatic diastasis of pubic symphysis: impact of loss of reduction on early functional outcomes

2021

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“…The goals of treating a symphysis diastasis include an appropriate reduction and a stable fixation to provide pelvic ring stability, which can effectively diminish the pain, and permit early mobility [6][7][8]. Numerous surgical methods have been described for treating pubic symphysis diastasis, including plating, external fixation, tension band wiring, sutures, and percutaneous fixation [6,[9][10][11][12]. Previous biomechanical studies have indicated that symphysis plating is effective in restoring the anterior ring stability [13], and it has often been used to treat cases of pubic symphysis diastasis worldwide [6].…”

Section: Introductionmentioning

confidence: 99%

“…Regardless of the various surgical methods, it is not uncommon to observe implant failure or a recurrent diastasis of the pubic symphysis from radiography during the postoperative follow-up. Some studies have presented postoperative hardware failure rates and recurrent diastasis rates ranging from 12% to as high as 75% after surgical fixation of a pubic symphysis diastasis [3,5,[10][11][12][13][14][15][16][17][18]. However, a relatively low revision rate has been reported, ranging from 0.7% to 8% [5,10,14,15,17,18].…”

Section: Introductionmentioning

confidence: 99%

The radiographic outcome after plating for pubic symphysis diastasis: does it matter clinically?

Tseng

Lin

Yang

2022

Arch Orthop Trauma Surg

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Introduction Open reduction and internal fixation with plates is the most widespread surgery in traumatic pubic symphysis diastasis. However, implant failure or recurrent diastasis was commonly observed during follow-up. The aim of our study was to evaluate the radiologic findings and clinical outcomes. Materials and methods Sixty-five patients with traumatic pubic symphysis diastasis treated with plating between 2008 and 2019 were retrospectively reviewed. The exclusion criteria were a history of malignancy and age under 20 years. Radiographic outcomes were determined by radiograph findings, including pubic symphysis distance (PSD) and implant failure. Clinical outcomes were assessed according to the Majeed score at the final follow-up. Results Twenty-eight patients were finally included. Nine patients (32%) experienced implant failure, including four (14%) with screw loosening and five (18%) with plate breakage. Only one patient underwent revision surgery. Postoperatively, a significant increase in PSD was observed at 3 months and 6 months. Postoperative PSD was not significantly different between patients with single plating and double plating, but it was significantly greater in the implant-failure group than in the non-failure group. The Majeed score was similar between patients with single plating and double plating or between the implant-failure group and the non-failure group. Body mass index, number of plates, age, and initial injured PSD were not significantly different between the implant-failure group and the non-failure group. Only a significant male predominance was observed in the implant-failure group. Conclusion A gradual increase in the symphysis distance and a high possibility of implant failure may be the distinguishing features of traumatic pubic symphysis diastasis fixation. The postoperative symphyseal distance achieved stability after 6 months, even after implant failure. Radiographic outcomes, such as increased symphysis distance, screw loosening, and plate breakage, did not affect clinical functional outcomes.

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“…Posterior xation has been proposed as a method of augmentation in fractures with some component of posterior ligamentous injury in order to reduce anterior implant failure [26]. Currently B3 fractures and C type fractures are managed with posterior xation, most frequently using sacroiliac screws, though failure rates remain high [15,27,28]. [3] [4] This study has many limitations arising from its retrospective nature and functional outcomes scores were not recorded at the same point in time.…”

Section: Discussionmentioning

confidence: 99%

Fixation Failure in Patients With Traumatic Diastasis of Pubic Symphysis: Impact of Loss of Reduction on Early Functional Outcomes.

Ponce

Ewertz

Tropa

2021

Preprint

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BackgroundFailure of fixation (FF) in pubic symphysis diastasis (SD) ranges between 12 to 75%, though whether it influences functional outcomes is still debated. The objective of this study is to evaluate the impact of anterior pelvic plate failure and loss of reduction on Majeed`s functional scores. MethodsSingle center retrospective review of consecutive patients with acute SD treated by means of anterior pubic plating. Thirty seven patients with a mean age 45.7+/-14.4 years, were included. Demographics, AO classification, pelvic fixation and secondary procedures were recorded. Majeed´s functional scores at minimum 6 months followup were compared according to the presence of FF and loss of reduction. ResultsFifteen patients presented FF. Eight presented an additional loss of symphyseal reduction. Mean Majeed´s score (MMS) in patients with and without FF was 64,4+/-13,04 and 81.8+/-15.65 respectively (p=0.0012). Differences in MMS in patients without FF and those with FF and maintained or loss of anterior reduction were 11,3 [70,5vs81,8] (p=0,092) and 22.7 [59,1vs81,8] (p=0,001) respectively. Significant association of FF with AO classification was noted. (OR 12.6; p=0.002).ConclusionsDifferences in MMS in the analysed groups suggest that loss of reduction might be more relevant than failure of the anterior osteosynthesis in functional outcomes.

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Can locking plate fixation of symphyseal disruptions allow early weight bearing?

Cited by 7 publications

References 22 publications

Fixation failure in patients with traumatic diastasis of pubic symphysis: impact of loss of reduction on early functional outcomes

Fixation failure in patients with traumatic diastasis of pubic symphysis: impact of loss of reduction on early functional outcomes

The radiographic outcome after plating for pubic symphysis diastasis: does it matter clinically?

Fixation Failure in Patients With Traumatic Diastasis of Pubic Symphysis: Impact of Loss of Reduction on Early Functional Outcomes.

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