The pubic midline exposure for symphyseal open reduction and plate fixation

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Surgical Techniques

Background:

• Open reduction and plate fixation of the symphysis pubis typically uses a Pfannenstiel incision.
• Challenging soft tissue conditions in the lower abdomen can complicate the Pfannenstiel approach.
• A vertical midline skin incision offers an alternative surgical exposure.

Purpose of the Study:

• To evaluate the feasibility and outcomes of using a vertical pubic area midline skin incision.
• To compare this approach with the traditional Pfannenstiel incision for symphysis pubis fixation.

Main Methods:

• Retrospective chart review of 25 patients treated between September 2011 and October 2012.
• Analysis of patient demographics, injury patterns (Young and Burgess classification), and mechanisms of injury.
• Assessment of surgical approach depth via CT scans, operative details, follow-up duration, and perioperative complications.

Main Results:

• Twenty-five male patients (average age 55.8 years, average BMI 29.3) were included.
• Average depth from skin to symphysis was 57.6 mm.
• Two perioperative complications occurred: one death from associated injuries and one deep infection. Average blood loss was 244 ml.

Conclusions:

• The vertical pubic midline skin incision is a feasible alternative for open reduction and plate fixation of the pubic symphysis.
• This approach can be beneficial in cases where the Pfannenstiel incision is less suitable due to soft tissue compromise.