Locked Overlapping Dislocation of the Pubic Symphysis into the Obturator Foramen: A Case Report

Abstract

usually involves hyperabduction or hyperextension of the os coxae. 1,2 We report a case of locked overlapping dislocation of the pubic symphysis, in which the pubis was locked into the obturator foramen. This may be the first report of this type of dislocation in the literature. CASE REPORTIn July 2004, a 20-year-old man was admitted to the Government Medical College, Thiruvananthapuram, India following a road traffic accident in which he was trapped between a wall and a reversing lorry. He sustained a low-velocity side-to-side compression injury. The patient was conscious and haemodynamically stable on admission. He was unable to walk or pass urine. A Foley catheter was introduced easily and the drained urine was clear. There was no evidence of external injuries other than a small bruise over the trochanteric area. Both anterior and superior iliac spines were at the same level, and there was no limb-length discrepancy. The patient was comfortable in a supine position, and both legs could be placed flat on the bed, with no apparent deformity. ABSTRACTA 20-year-old man sustained an overlapping dislocation of the pubic symphysis following a lowvelocity side-to-side compression injury. Such injuries are rare in the literature. This case, where the pubis was locked into the obturator foramen, may be the first of its kind to be reported. The pubic symphysis was successfully reduced by levering, with difficulty, the locked pubic body out of the left obturator foramen. As the reduction was unstable, the pubic symphysis was fixed with 2 reconstruction plates. The patient was able to mobilise fully after 3 months and returned to work. At 18 months' follow-up he was able to void urine normally after urethral repair.

Locked pubic symphysis—A case series

“…Patient was asymptomatic at follow-up. Sreesobh [7] described a similar injury where the pubis had entered the obturator foramen. Sacroiliac joints were involved whilst urethra and bladder were normal.…”

“…No major neurovascular injury was described by any author in their case report either preoperatively or during surgery. [4][5][6][7]9 The pubic symphysis is considered a midline structure. The pubic symphysis which has moved across the midline is to be considered as the side of lesion.…”

“…The injury pattern is usually associated with urethral injury. 2,3,7 Closed reduction can be attempted by using the femur as a lever by locking it in flexion, abduction and external rotation. The iliofemoral ligaments are thought to hold the femoral head within the acetabulum and to allow reduction with a gentle abduction and rocking motion of the limb.…”

Closed reduction and fixation of locked symphysis pubis using tubular external fixator: a case report

“…[1] The main structure that prevents unlocking is the pubic tubercle. [2][3][4][5] Eggers [6] reported that loading gently may reduce a displaced pubic bone while the knee is in flexion of 90 degrees and the hip is in abduction and external rotation. However this maneuver has the risk of causing fracture in the femoral neck.…”

Le lussazioni della pelvi

“…Presentano frequenti rischi lesionali nel maschio (uretra, prostata, plesso venoso prostatico); con una certa frequenza esitano in insufficienza erettile. In letteratura esistono molti case report al riguardo [9][10][11][12][13][14][15]. Maqungo propone una classificazione in tre gradi di gravità crescente; il 2°e il 3°grado richiedono sempre un trattamento chirurgico.…”