Pelvic ring disruption is often due to high energy trauma.
When the pelvic ring is disrupted it can lead to pubic symphysis diastasis orrami fractures anteriorly, and varying degrees of ligamentous injury orfractures around the sacroiliac joint posteriorly. Pelvic ring injuries can beclassified according to Young and Burgess Classification which is based on themechanism and severity of the pelvic ring disruption(1).In an unstable pelvic ring disruption the goals of treatment is anatomicreduction and stable fixation of the pelvic ring to aid in early mobilisation,thereby avoiding post-traumatic pulmonary compromise and other morbidityassociated with prolonged bed rest. It is now well know that fixation of the pubicsymphysis disruption plays a greater role in the stability of pelvis in anunstable pelvic ring injury. Various studies have shown that in an unstablepelvic ring injury, regardless of mode of fixation in the posterior pelvis,adjunctive anterior pelvic fixation of the disrupted pubic symphysis augmentspelvic stability and prevents deformity and malunion(2)(3)(4)(5).
Anterior pelvic stabilisationtechniques are broadly classified into external and internal fixation. Openreduction and internal fixation of pubic symphysis disruption with plate andscrews remains popular as it delivers most rigid fixation with relatively lesscomplications (6)(need more evi). Various plate constructs such as twohole, multi-hole and multi-planar plates have been used, however the preferenceis more towards using single anterior multi-hole plate(7–10). The rigidity of the plate andscrew fixation could theoretically limit the normal physiologic movement at thepubic symphysis. Multiple studies have reported radiological failure of pubicsymphysis plate fixation, however clinical significance of this radiologicalfailure of fixation is still questionable(9)(11)(7)(12).Although post-operative rehabilitation after fixation of unstable pelvic injuryis still debated, most surgeon’s favour non-weight bearing or limited weightbearing for several weeks due to concerns of fixation failure(10).
At our centre we routinely uselocking pubic symphysis plate with an aim to allow patients to weight bearearly. Locking plate concept for pubic symphysis fixation is relatively new.There are concerns that using locking plate for pubic symphysis disruption canlead to catastrophic failure of the implant due to the nature of fixed angleconstruct the locking plate offers in relation to the physiological movement atpubic symphysis.
Although there are several bio-mechanical cadaver and saw bonestudies comparing locking and non-locking plate use for pubic symphysisdisruption, there is paucity of literature evaluating the clinical use ofsymphyseal locking plates(13–15). With this largest clinicalcase series we present our experiences in using locking plate for pubicsymphysis disruption.