Box plate fixation of the symphysis pubis: biomechanical evaluation of a new technique

The purpose of this study was to compare common techniques of pubic symphyseal fixation with a new method, the "box plate," for fractures of the pelvis where the bone is osteopenic. This symphyseal fixation construct consists of two, two-hole, 4.5-mm narrow dynamic compression plates (DCP) oriented parallel to one another. One plate is recessed within the symphysis, and the other is located on the pubic tubercles. The plates are interlocked using two 6.5-mm fully threaded screws, forming a box-like construct. To determine the mechanical properties of this construct, five fresh, cadaveric pelvic specimens with a mean age of 75 years were harvested. The femora of each specimen were potted into containers and fixed to the base of a materials testing machine. The pelvis was constrained from rotating about the hip joints by anterior and posterior restraints. A vertical compressive load was applied through the lumbar spine. Force to a magnitude of 1,000 N was applied through three cycles. Gapping motions at the symphysis pubis (SP) and the sacroiliac (SI) joints, and flexion-extension of the sacrum with respect to the ilia were measured under the following conditions: (a) intact, (b) SP ligament, unilateral anterior SI ligaments, and ipsilateral sacrospinous and sacrotuberous ligaments disrupted (anteroposterior compression type II injury), and these injuries fixed using (c) a 4.5-mm narrow two-hole DC plate placed on the superior SP held by two cancellous bone screws, (d) the DC plate well as a single 7.0-mm cannulated cancellouoffliosacral lag screw across the injured SI joint, (e) the DC plate and a five-hole 3.5-mm reconstruction plate on the anterior SP, (f) a 3.5-mm, four-hole, DC plate on the superior SP using four fully threaded screws, and (g) the box plate symphyseal construct described above. All fixations reduced SP joint gapping compared to the disrupted joint. However, all but the box plate still allowed significantly greater motion than the intact SP joint. No fixation significantly reduced SI joint gapping or sacral flexion compared to the injured state.