Clinical and radiological short-term outcomes of pubic symphysis diastasis treated with modified pedicle screw-rod fixation.
PURPOSE
Pubic symphysis diastasis with an incidence of approximately 20% in pelvic fractures is a severe lesion which needs to be treated properly. The objective of this retrospective study was to describe and evaluate the clinical and radiological outcomes including its advantages and limitations of this modified minimal invasive technique.


METHODS
Totally 29 patients with pubic symphysis diastasis, with or without posterior ring instability, were treated by modified pedicle screw-rod fixation (modified PSRF) between January 2010 and December 2016. The duration from injury to surgery, operation time, intraoperative blood loss as well as complications were recorded. During follow-up, the functional outcomes were assessed according to the Majeed evaluation criteria 1 year postoperatively. The evaluation of the postoperative reduction quality was carried out according to Matta criteria.


RESULTS
According to Tile classification, there were 9 cases of Type B1 underwent only anterior-modified PSRF and 20 cases of Type C1 experienced anterior-modified PSRF combined with posterior fixation. The duration from injury to operation, operation time and intraoperative blood loss were 3.27 days (range 1-6 days), 42.07 min (range 38-45 min), and 46.14 ml (range 40-55 ml). The results of reduction quality were rated as excellent in 16, good in 11 and fair in 2 based on Matta criteria. The Majeed functional scores ranged from 68 to 95 and there were excellent in 15, good in 12 and fair in 2. No patients experienced incision infection. Slight loosening of middle-two screws was verified during follow-up in one patient. Two patients underwent femoral nerve palsy. Irritation to the LFCN was detected in four patients.


CONCLUSIONS
Modified PSRF can be performed as an alternative to manage pubic symphysis diastasis due to its merits of minimal invasive, less blood loss, less soft tissue injuries as well as shorter operation time, even with the early weight-bearing.


TRIAL REGISTRATION
Researchregistry3905.
['Wang|Jiandong|J|', 'Cao|Lei|L|', 'Wu|Jianhong|J|', 'Wang|Qiugen|Q|', 'Bi|Chun|C|']
D000328:Adult D016063:Blood Loss, Surgical D005260:Female D005593:Fracture Fixation, Internal D050723:Fractures, Bone D006801:Humans D008297:Male D008875:Middle Aged D019060:Minimally Invasive Surgical Procedures D061646:Operative Time D065289:Pedicle Screws D010384:Pelvic Bones D046548:Pubic Symphysis Diastasis D012189:Retrospective Studies
Pubic symphysis diastasis Modified pedicle screw–rod fixation