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A CT scan reveals a lateral compression pelvic fracture with a posterior locked pubic symphysis entrapped against the pubic tubercle.
Source publication
A locked pubic symphysis occasionally occurs after a lateral compression injury of the pelvic ring. One pubic bone becomes entrapped behind the contralateral pubis. Lateral compression pelvic injuries are well recognized, but a lateral compression pelvic injury resulting in a locked pubic symphysis is rare. We describe a locked pubic symphysis with...
Context in source publication
Context 1
... hospital with a report of a transected urethra. The patient's radio- graphs showed the right pubis was trapped in the obturator ring of the left hemipelvis (Fig. 1). Computed tomography (CT) scans confirmed a pelvic fracture with a right posteri- orly displaced pubic symphysis in the left obturator foramen, entrapped by the right pubic tubercle (Fig. 2). In addition, the CT scan showed a right sacral fracture (Fig. 3). There were no additional ...
Similar publications
Locked symphysis pubis is a kind of pelvic injury in which one pubic bone is jammed in the back of the other or opposite the obturator foramen following lateral compression forces. In this article, we present a 31-year-old female case of locked symphysis pubis which was treated by closed reduction using tubular external fixator. We believe that tub...
Citations
... However, it cannot be confirmed that all healed fractures in this woman occurred in the same event. In female QH34aa, it is possible that the "locking" of the symphysis prevented a more severe lesion of the posterior ring (Cannada and Reinert, 2009). Pelvic ring interruptions are associated with elevated mortality and severe complications (Giannoudis et al., 2007;Báez-Molgado et al., 2015;Coccolini et al., 2017;Leach et al., 2019); however, both women survived, likely with gait alterations (Stover et al., 2017) and coxofemoral joint imbalance. ...
Objective: To evaluate the presence of a trauma that results in pelvic ring disruption and its clinical implications in two individuals from ancient Egypt.
Materials: Two complete skeletons of adult women, dated to the Middle Kingdom (c. 1980–1760 BCE), from two tombs in the necropolis of Qubbet el-Hawa (Aswan, Egypt).
Methods: The anatomical elements were examined macroscopically in Egypt.
Results: Unilateral sacroiliac luxation with disruption of the pubic symphysis was detected in both individuals. The presence of an overlapped symphysis was evident in female QH34aa. A healed fracture of the iliopubic ramus are present in female QH122. Antemortem bone alterations in the pelvis demonstrate that they survived
the trauma.
Conclusions: Pelvic trauma due to a lateral compression was detected in the os coxae. Both women survived but probably had severe sequelae that impaired their quality of life. At least one of them might have received some type of medical treatment.
Significance: Both cases shed light on pelvic fractures, their mechanisms of production, and their effects on bone and its functionality, as well as revealing possible associated lesions of soft tissues and vital organs.
Limitations: The pelvis, or at least the pubic symphysis, must be well preserved to allow the correct diagnosis of this type of lesion.
Suggestions for further research: Studies are warranted on the detection of this type of fracture, focusing on the subtle bone changes that indicate its presence. There is also a need to develop methodologies that combine the study of bone and soft tissue alterations.
... It may be associated with an accompanying urethral injury. There are very few case reports in literature regarding locked pubic symphysis [5,6]. In this case report, we present a patient who was managed with open reduction and internal fixation method. ...
Regarding the fact that lateral compression is usually not the underlying mechanism of fracture, Locked pubic symphysis is a very rare injury. At most times it can be managed with closed reduction method; however, open reduction with or without internal fixation may sometimes be required. In rare cases, osteotomy is the only choice. Urethral or bladder damage can occasionally be found. In this study, we presented a case of locked pubic symphysis with failed closed reduction who underwent successful open reduction with internal fixation.
... This unique injury is characterized by overlapping pubic symphysis disruption, the pubic bone on one side entrapped behind or very rarely anterior to the contra lateral pubic rami. [1][2][3][4][5][6][7][8][9] Only a very small proportion of pelvic trauma resulting from lateral compression injuries end up as locked pubic symphysis injuries. 1 A locked pubic symphysis is quiet rare injury and even more when associated with acetabular fracture. ...
... Locked or overlapping symphysis pubis is lateral compression injury where the intact pubis on one side moves behind or rarely in front of the contralateral intact pubis. [1][2][3][4][5][6][7][8][9] It is caused by hyperextension and adduction forces on the hip and femur of the affected side. Theoretically, internal or external rotation of the femur displaces the pubic bone posterior or anterior to the contra lateral intact pubic body. 1 It is a rare injury, not more than 30 case reports written in English language literature on this particular case. ...
Background:
Locked pubic symphysis or overlapping symphysis is a rare injury which happens when a pubic bone displaces behind the contra lateral pubic rami. It usually arises from lateral compression injuries. In this case report, we try to share our experience on the operative fixation of locked pubic symphysis and concomitant ipsilateral acetabular fracture.
Case presentation:
A 24-year-old male patient presented after a road traffic accident with lateral compression injury to the pelvis. He was found to have locked pubic symphysis, right side transverse acetabular, and right side closed tibial fracture. He was taken to the operation theater 10 days later after he was managed for the additional chest contusion he had. Successful open reduction and plate fixation of the overlapped symphysis and percutaneous screw fixation of the ipsilateral acetabulum were done at the same time. An intramedullary nail was inserted for the tibial fracture.
Conclusion:
Locked symphysis is a rare trauma and even more complex when associated with acetabular fracture. Both situations may happen at the same time and could be managed operatively.
... The reasons postulated are that the female pubic symphysis has a thicker cartilaginous disc, also female pelvis has greater mobility and larger inner diameter than male pelvis [5]. OPSD can be associated with posterior pelvic ring injury ranging from buckle fracture of sacrum to complete sacroiliac disruption [11]. Shanmugasundaram [6] in 1970 reported a case of symphysis pubis dislocation without locking into the obturator foramen. ...
... The injury was hypothesized to have been caused by either side-to-side compression or hyperextension. Cannada and Reinert [11] reported the use of external fixators for maintenance of reduction in their series, as the patients had undergone previous suprapubic catheterization. However, in our case, no infection was observed with anterior plate fixation even when the patient had SPC insitu. ...
Introduction:
Overlapping pubic symphysis dislocation (OPSD) or a locked pubic symphysis is a compression of the pelvic ring with the intact pubis trapped into the contralateral obturator foramen. Reduction can be difficult and contralateral suprapubic osteotomy is a good way to address the irreducible OPSD. The technique has only been discussed thrice in the available literature.
Case report:
We report the case of a 26-year-old man who had his right pubic ramus entrapped within the contralateral obturator foramen, having an overlap of >4 cm with associated ipsilateral sacroiliac joint (SI joint) disruption and urethral injury. When all the maneuvers of closed and instrumented open reduction failed, we performed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus. The osteotomy site was stabilized with a 6-hole recon plate and SI joint was stabilized with a 6.5mm percutaneous sacroiliac screw. The patient underwent delayed urethral repair at 10 weeks after the index surgery. At 3-year follow-up, the patient did not report any pubic discomfort, urinary and sexual problems.
Conclusion:
Locked OPSD is a rare injury and is frequently associated with sacroiliac and urethral injuries. Distraction osteotomy of the contralateral superior pubic ramus is a viable option for irreducible cases.
... 14,16 An OPSD or a locked pubic symphysis is a subtype of lateral compression injury and may also be classified as a Tile-type B2 fracture complex. 3,14,16 Urethral injury is the most commonly associated non-orthopedic injury (7% e 55%). 4e8, 13,18 It mainly occurs due to the shearing forces, formed due to the overlapping and vertical displacement of the pubic bone. ...
... The pubic symphysis which has crossed over the midline is considered to be the side of the lesion. 1,3,14,15 Egger et al. 1 was the pioneer who described locking of the symphysis pubis with no obvious injury to any other portion of the pelvic ring. He postulated 2 types of dislocations of the ox coxae: the hyperabduction and the hyperextension type. ...
... Achieving reduction is always difficult and all the aforementioned techniques may fail because of the presence of associated injuries and the involvement of the pelvic musculature and ligaments. 2,3,5,13,18 Anatomically, the arcuate ligament is considered to be the solitary stabilizer of the symphysis pubis, while the superior, anterior, and posterior ligaments are secondary restraints. 1,14e17 Following the disruption of these ligaments, the migrated pubis may come to lie either anterior or posterior to the opposite side. ...
A locked pubic ramus body is an unusual variant of lateral compression injury. Till date, there have been only 25 cases reported in published literature. We herein describe a case where the right pubic ramus was entrapped within the opposite obturator foramen with an overlap of greater than 4 cm, with associated urethral injury. When all maneuvers of closed and instrumented reduction failed, we performed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus. The osteotomy site was stabilized with a 6-hole recon plate. The patient underwent delayed urethral repair 10 weeks after the index surgery. At three-year follow-up, the patient has sexual dysfunction especially difficulty in maintaining erection, secondary urethral stricture, heterotopic ossification, and breakage of implants.
... Egger was the first to describe this type of injury in 1952 [4]. To date, there are twenty-one cases in the literature since the original description [1,2,[5][6][7]. These injuries often stem from high energy blunt trauma, usually in consequence of motor vehicle accidents [8]. ...
... Some authors described the female pubic symphysis with a thicker cartilaginous disc and 2-3 mm greater mobility than the male pelvis. This contributes to its stability contrasted to the male pelvis [6]. The LSP can either be anterior or posterior [1]. ...
... Most authors advocate for fixation of the sacrum by the percutaneous method using ISJ screw [6,9,21]. The reduction was stabilised using a trans-symphyseal screw of 60 mm × 4.5 mm, after external fixation with Hoffman external fixator. ...
Background
Locked symphysis pubis is an exceedingly rare pelvic injury especially in the paediatric population. This study is the first to describe this fracture in a skeletally immature patient.
Case report.
We report the case of a fifteen year old boy who presented to the Emergency Department (ED) after being involved in a farming injury with a left lateral compression pelvic trauma. He sustained Locked Symphysis Pubis (LSP) and internal pelvic bleeding from the right Internal Iliac Artery (IIA). He was treated successfully by selective embolization of the ILA followed by closed reduction of the LSP and percutaneous fixation of the SI joint.
Conclusion
Locked symphysis pubis in the paediatric population is an exceedingly rare injury among lateral compression type pelvic fractures. Careful assessment and preoperative management planning are encouraged. Open packing of the pelvis in case of internal bleeding should be avoided in paediatric patients, only selective embolization is advocated. Closed reduction of the LSP by using the external fixator as a lever arm for reduction followed by percutaneous fixation of the SI joint. Moreover, changing the patient position to prone position followed by posterior lumbar spine stabilisation is our preferred method of treatment.
... Presentano frequenti rischi lesionali nel maschio (uretra, prostata, plesso venoso prostatico); con una certa frequenza esitano in insufficienza erettile. In letteratura esistono molti case report al riguardo [9][10][11][12][13][14][15]. Maqungo propone una classificazione in tre gradi di gravità crescente; il 2°e il 3°grado richiedono sempre un trattamento chirurgico. ...
... Maqungo propone una classificazione in tre gradi di gravità crescente; il 2°e il 3°grado richiedono sempre un trattamento chirurgico. Sono lussazioni tipiche dei maschi perché, come suggerito da Cannada e Reinert [12], la sinfisi delle donne ha un disco più spesso e una mobilità maggiore. Il trattamento è chirurgico, con accesso di Pfannestiel e osteosintesi interna. ...
Pelvic dislocation is a rare event. In the English-language literature only one case report has been reported. In this article we discuss the traumatic and post-partum dislocation of the pelvic joint, the modality of occurrence and the possible treatment
... However this maneuver has the risk of causing fracture in the femoral neck. It is reported that reduction may be provided by stabilizing the opposite iliac bone and using the femur as a lever in Figure 4 [7] or by applying longitudinal traction to the affected lower extremity; [6,8] by applying lateral compression while pressing directly on the symphysis pubis; [2,4] or by pressing on the symphysis pubis while distracting bilaterally over both iliac crests. [3] Botanlıoğlu et al. [9] reported that after lateral compression provided by an external fixator placed on both iliac crests, open reduction could be obtained by force applied from the anterior to the posterior with an elevator as a convex surface directed towards the pelvis placed between the pubic bone and opposite the pubic tubercle through the obturator foramen. ...
Locked symphysis pubis is a kind of pelvic injury in which one pubic bone is jammed in the back of the other or opposite the obturator foramen following lateral compression forces. In this article, we present a 31-year-old female case of locked symphysis pubis which was treated by closed reduction using tubular external fixator. We believe that tubular external fixators are useful devices to perform closed reduction maneuvers for locked pelvic injuries and also help to reduce the need for open reduction and internal implant usage.
... Irreducible overlapping pubic symphysis dislocation is an uncommon form of pelvic injury [1][2][3][4][5][6][7][8][9][10][11][12][13]. It occurs when the affected pubic becomes trapped behind the contralateral pubis. ...
... It occurs when the affected pubic becomes trapped behind the contralateral pubis. Urethral injuries are frequently associated [1][2][3][4][5][6][7][8]14]. We report one such case with an overlapping pubic symphysis dislocation locked into the contralateral obturator foramen that was refractory to closed or open reduction. ...
... To the best of our knowledge, seventeen similar cases have been already reported (Table 1). In all 17 cases, urinary tract lesions occurred in nine times [1][2][3][4][5][6][7][8]. They consisted of urethral disruption, eight of them required bladder drainage by mean of a suprapubic catheter [1][2][3][4][5][6][7]. ...
Locked pubic symphysis is a rare form of pelvic injury. It occasionally occurs after a lateral compression injury of the pelvis. We described an overlapping pubic symphysis dislocation that was locked into the contralateral obturator foramen. To the best of our knowledge, there are about seventeen similar cases reported in the literature. The pubic symphysis was finally reduced by means of a superior pubic ramus osteotomy to unlock the incarcerated pubic body out of the contralateral obturator foramen. As the reduction was unstable, the pubic symphysis was fixed with a reconstruction plate. The patient recovered completely and returned to normal activities within 4months. At 1year's follow-up she reported no discomfort in the pubic symphysis region and was able to void urine normally.
... [1][2][3] ‹lk olarak 1952 y›l›nda tan›mlanan bu yaralanmalar›n literatürde az say›da ol-du¤u bilinmektedir. [4][5][6][7][8][9][10][11] Pubik simfizisin ayr›lmas›n› takiben bir pubik kemi¤in karfl› taraftaki pubik kemik arka-s›nda s›k›flmas› sonras› oluflur. S›k›flma bazen obturator foramen içinde de oluflabilir. ...
... [5,6] Figür dört pozisyonunda karfl› taraf iliak kemik stabilize edilirken, femuru bir manivela gibi kullanarak redüksiyon sa¤lanabilece¤i bildirilmifltir. [4] Simfizis pubis üzerine direkt uygulanan bask› ile birlikte lateralden kompresyon redüksiyon için önerilen di¤er bir yöntem- dir. [8,10] Bunun d›fl›nda her iki iliak kemik üzerinden lateral distraksiyon gücü ve simfizis üzerinden uygulanan bask› ile redüksiyon da önerilmektedir. ...
... [9] Obturator foramen içinde e¤er kilitlenme varsa, lateralden distraksiyon manevras› baflar›s›z olmaktad›r. [4] Olgumuzda lateralden kompresyon daha önce hastaya konulmufl olan eksternal fiksatör arac›l›¤› ile yap›l›rken, yine anteriorden posteriora do¤ru kuvvet uygula-mas› ise elevator yard›m› ile sa¤lanm›flt›r. ‹liak kanat lateral kompresyon uygulaman›n da aç›k redüksiyon ifllemini kolaylaflt›rd›¤›n› olgumuzda gördük. ...
A locked pubic symphysis can occur following a lateral compression injury of the pelvic ring when one pubic bone becomes entrapped behind the contralateral pubis or obturator foramen. In selecting the treatment modality, it is important to know the mechanism of injury. We presented the use of an open reduction technique in the treatment of a locked pubic symphysis in which open reduction external fixation application failed in the emergency department.
