Scholarlink

Objective <p>Describe percutaneous screw fixation of symphyseal disruption as an alternative to open reduction and plate fixation.</p> Indications <p>Pelvic ring fractures with symphyseal disruption ≥ 25 mm (anteroposterior compression [APC] type&#xa0;II, lateral compression [LC] type&#xa0;I and&#xa0;II).</p> Contraindications <p>Open reduction is required if closed reduction fails. Obesity or hernia may hinder screw insertion.</p> Surgical technique <p>Reduction with a&#xa0;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&#xa0;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&#xa0;V-configuration with the superior screw placed in a&#xa0;transverse direction and the inferior screw oblique, or an X‑configuration with both screws oblique and crossing at the symphysis can be used.</p> Postoperative management <p>Thromboprophylaxis for 6–12&#xa0;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&#xa0;weeks. If posterior injury is unilateral, the contralateral leg may fully weight-bear. Follow-up with x‑rays should be obtained 6&#xa0;weeks postoperatively and weight-bearing can commence. Additional follow-up 6&#xa0;months postoperatively.</p> Results <p>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.</p>

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Percutaneous screw fixation of pubic symphysis diastasis

  • 期刊论文

  • 发表日期：

    2026年8月3日

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  • Nicole M. van Veelen,
  • Julia J. Chan,
  • Björn-Christian Link,
  • Peter D. Bates

摘要

Objective

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

Indications

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

Contraindications

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

Surgical technique

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.

Postoperative management

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.

Results

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.