Percutaneous screw fixation of pubic symphysis diastasis

Describe percutaneous screw fixation of symphyseal disruption as an alternative to open reduction and plate fixation.

Pelvic ring fractures with symphyseal disruption ≥ 25 mm (anteroposterior compression [APC] type II, lateral compression [LC] type I and II).

Open reduction is required if closed reduction fails. Obesity or hernia may hinder screw insertion.

Reduction with a Weber clamp placed percutaneously. Using C‑arm imaging, the first guide wire is introduced percutaneously from one pubic tubercle across the symphysis. The near cortex is drilled with a cannulated drill bit prior to inserting the 7.3 mm cannulated screw. The second screw is placed in the same fashion from the contralateral side. Either a V-configuration with the superior screw placed in a transverse direction and the inferior screw oblique, or an X‑configuration with both screws oblique and crossing at the symphysis can be used.

Thromboprophylaxis for 6-12 weeks. Obtain postoperative x‑rays with anteroposterior, inlet and outlet views. In case of bilateral posterior injury, the patient should remain nonweight-bearing for 6 weeks. If posterior injury is unilateral, the contralateral leg may fully weight-bear. Follow-up with x‑rays should be obtained 6 weeks postoperatively and weight-bearing can commence. Additional follow-up 6 months postoperatively.

The authors have performed and documented eight cases treated with this technique. One patient had an open fracture and developed an implant-associated infection requiring revision surgery. Follow-up information for one patient could not be obtained. Radiological signs of screw loosening or breakage was visible in four cases; however, all patients showed good outcomes, and no implant removal was required.