Pelvic ring disruption is often due to high energy trauma.
When the pelvic ring is disrupted it can lead to pubic symphysis diastasis or
rami fractures anteriorly, and varying degrees of ligamentous injury or
fractures around the sacroiliac joint posteriorly. Pelvic ring injuries can be
classified according to Young and Burgess Classification which is based on the
mechanism and severity of the pelvic ring disruption(1).
In an unstable pelvic ring disruption the goals of treatment is anatomic
reduction and stable fixation of the pelvic ring to aid in early mobilisation,
thereby avoiding post-traumatic pulmonary compromise and other morbidity
associated with prolonged bed rest. It is now well know that fixation of the pubic
symphysis disruption plays a greater role in the stability of pelvis in an
unstable pelvic ring injury. Various studies have shown that in an unstable
pelvic ring injury, regardless of mode of fixation in the posterior pelvis,
adjunctive anterior pelvic fixation of the disrupted pubic symphysis augments
pelvic stability and prevents deformity and malunion(2)(3)(4)(5).
Anterior pelvic stabilisation
techniques are broadly classified into external and internal fixation. Open
reduction and internal fixation of pubic symphysis disruption with plate and
screws remains popular as it delivers most rigid fixation with relatively less
complications (6)(need more evi). Various plate constructs such as two
hole, multi-hole and multi-planar plates have been used, however the preference
is more towards using single anterior multi-hole plate(7–10).
The rigidity of the plate and
screw fixation could theoretically limit the normal physiologic movement at the
pubic symphysis. Multiple studies have reported radiological failure of pubic
symphysis plate fixation, however clinical significance of this radiological
failure of fixation is still questionable(9)(11)(7)(12).
Although post-operative rehabilitation after fixation of unstable pelvic injury
is still debated, most surgeon’s favour non-weight bearing or limited weight
bearing for several weeks due to concerns of fixation failure(10).
At our centre we routinely use
locking pubic symphysis plate with an aim to allow patients to weight bear
early. Locking plate concept for pubic symphysis fixation is relatively new.
There are concerns that using locking plate for pubic symphysis disruption can
lead to catastrophic failure of the implant due to the nature of fixed angle
construct the locking plate offers in relation to the physiological movement at
pubic symphysis. Although there are several bio-mechanical cadaver and saw bone
studies comparing locking and non-locking plate use for pubic symphysis
disruption, there is paucity of literature evaluating the clinical use of
symphyseal locking plates(13–15). With this largest clinical
case series we present our experiences in using locking plate for pubic