Trans-symphyseal fixation for complex anterior pelvic fractures: a novel technique guide and case series

To describe a novel percutaneous technique utilizing a curved intramedullary implant for fixation of complex anterior pelvic ring fractures and to report preliminary clinical outcomes from a retrospective case series.

Retrospective case series.

Single academic Level I trauma center.

Nine female patients (mean age 74.8 years, range 53-89 years) with anterior pelvic ring injuries treated with percutaneous trans-symphyseal fixation using a curved intramedullary device between June 2023 and December 2024. All patients were treated by a single orthopaedic trauma surgeon and followed for a minimum of 6 months.

Percutaneous intramedullary fixation of the superior pubic ramus crossing the pubic symphysis and terminating in the contralateral ramus using a novel flexible, curved implant.

Operative time, estimated blood loss, implant complications, fracture union, and discharge disposition.

The novel technique was successfully performed in all 9 patients. Average total surgical time was 106.3 minutes, with a mean of 54.8 minutes dedicated to the anterior fixation. Average estimated blood loss was 132.2 mL. All fractures progressed to union with no cases of implant failure or surgical site infection. Assistive measures were required in 3 of 9 cases. Discharge disposition was favorable, with 5 of 9 patients discharged to home or acute rehabilitation. No complications related to the anterior implant were noted.

This retrospective review suggests that trans-symphyseal curved intramedullary fixation is a feasible and safe technique for managing anterior pelvic ring fractures, including fragility and high-energy patterns. The method provides stable fixation while minimizing operative time, blood loss, and surgical exposure. Further studies are warranted to compare this technique against established modalities in larger cohorts.

Level IV-Therapeutic study.