W-shaped double plating for symphyseal diastasis in vertical shear pelvic ring injury: 12-month radiographic
Leonardo Vasconcelos Coelho1, Laís Kubo de Lima1, Julio Yukio Konasugawa1
1Department of Orthopedic Trauma, Hospital Municipal de Parelheiros Josanias Castanha Braga - 841 Euzébio Coghi Street - Jardim Roschel, São Paulo - SP, 04883-290, Brazil.
Abstract:
Vertical shear pelvic ring injuries require robust stabilization to prevent loss of reduction. We report a 36-year-old male motorcyclist with a Tile C1 unilateral vertical shear pelvic injury, presenting 42 mm pubic symphysis diastasis and ligamentous disruption. After temporary external fixation, definitive treatment used an anterior intrapelvic approach with anatomically contoured W-shaped double plating, allowing placement of long bicortical screws into the superior pubic ramus/anterior column, combined with percutaneous S1 iliosacral screws. Toe-touch weight bearing was recommended at 2 weeks postoperatively; however, the patient progressed to full weight bearing at this stage, without significant discomfort, and achieved full squat without pain by 4 weeks. At 12 months, pelvic alignment remained stable with no implant failure or symphyseal widening. Complete radiographic osseous bridging was not observed, yet the patient achieved excellent functional recovery. Reinforced double plating enabling long anterior column-directed screws may enhance anterior ring stiffness in unstable injuries where single plating may be insufficient.
