Experience in early minimally invasive fixation of pubic symphysis disruption with a system of transpedicular screws in patients with combined pelvic trauma (pilot study)

Abstract

Introduction Challenges of treating the injuries of pubic symphysis in patients with combined pelvic injury require developing new techniques for stable minimally invasive osteosynthesis in the acute period of trauma.Purpose of the work was to assess the application of low invasive fixation of the pubic symphysis with a system of transpedicular screws in the patients with combined unstable pelvic injuries in the acute period of the traumatic disease.Materials and methods The results of treatment of 12 patients with polytrauma with unstable pelvic injury with rupture of the pubic symphysis who were treated at Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, in the period from 2017 to 2023, were analyzed. All the patients underwent final minimally invasive fixation of the pubic symphysis with a system of transpedicular screws in the early period of the traumatic disease.Results The overall assessment of the results in 12 patients found no complications or technical errors during the installation of transpedicular screws. Control CT scans of the pelvis showed that osteosynthesis was stable in all patients, and the position of metal was correct in all. One patient from the study group died in the clinic from massive pulmonary embolism. The long-term results in 11 patients in the period from 6 months to 3 years after trauma were evaluated as excellent and good anatomical and functional results in 10 patients, one case had fair outcome.Discussion The use of bone plates to fix ruptures of the symphysis pubis leads to disruption of its physiological mobility, and the patient’s activity in the postoperative period can cause an implant fracture. Original dynamic plates and wire cerclage help avoid this complication; however, all these techniques involve significant surgical trauma and blood loss, as well as the risk of postoperative wound suppuration. Minimally invasive methods of  fixation using cannulated screws, systems such as Endobutton, Tight Rope can reduce intraoperative trauma and the risk of complications (blood loss, suppuration); however, the procedure for their installation is quite complex and lengthy, and for greater stability, external fixation of the pelvic ring is often required. The  proposed minimally invasive fixation of the pubic symphysis with a system of transpedicular screws avoids a lot of shortcomings and is sufficiently stable.Conclusion The method of minimally invasive fixation of the pubic symphysis with a system of transpedicular screws meets current requirements in the treatment of patients with polytrauma and unstable pelvic injury, and it may be successfully used in the acute period of trauma.