Locked pubic symphysis—A case series.

Abstract: Background: Locked pubic symphysis is an unusual form of pelvic injury. In this the intact pubis gets trapped against contralateral pubis. Closed reduction can be attempted though often requires open reduction and internal fixation. This paper is presented for its rarity and probably first case series on locked pubic symphysis from single institute. Materials and methods: Three cases are presented from the Institute of Orthopaedics and Traumatology, Government General Hospital and Madras Medical College, Chennai from February 2007 to July 2009. Initially closed reduction was attempted but was not possible, so open reduction was planned. Open reduction was successful in all cases with some difficulty and fixed with symphysial plating. All patients were followed up for functional outcome for a mean follow-up of 15 months. Discussion: This is the first time in the literature a case series of locked pubic symphysis is presented. In all cases it was found that anterior superior iliac spine on the affected side had moved closer to the midline compared to the opposite side. Though suprapubic cystostomy is a contraindication for pfannensteil incision, we have reduced three cases by this incision and done internal fixation with no postoperative wound infection. We were able to reduce the locked pubis with simple maneuvers and with no special distraction instruments. We did not require any osteotomy for the reduction which is a disadvantage as it may produce healing problems. Conclusion: Locked pubic symphysis is a rare form of pelvic injury. Though conservative closed reduction maneuvers have been described open reduction is often required. Internal fixation helps not only in stabilizing the anterior rim of pelvis but also the posterior aspect by stabilizing the sacro iliac joint which improves pelvic stability and promotes recovery. [Copyright &y& Elsevier]