Percutaneous closed reduction for locked pubic symphysis using a modified subcristal external fixator: A case report

A locked pubic symphysis is a variant of lateral compression pelvic ring injury, characterized by the overlap of one pubis over the contralateral pubis. One challenge with locked pubic symphysis is the difficulty of achieving closed reduction. In this report, we present a case of a 17-year-old boy who sustained a locked pubic symphysis and was successfully treated with percutaneous reduction using a modified subcristal external fixator. After failed manual closed reduction, 5 mm pins were inserted 3 cm away from the anterior superior iliac spine to prevent injury to the lateral femoral cutaneous nerve. The pins were advanced through the iliac crest until bicortical fixation was achieved. For percutaneous closed reduction, the pins were used as joysticks to manipulate the hemipelvis, successfully achieving reduction. Percutaneous closed reduction using a modified subcristal external fixator for locked pubic symphysis is a less invasive alternative to conventional open reduction following failed closed reduction. It carries a lower risk of complications, such as nerve injury, and is worth attempting before resorting to open reduction.