Overlapping dislocation of the pubic symphysis: report of three cases and review of the literature

Urethral entrapment by an overlapping dislocation of the pubic symphysis in a cat

Case summary

A 1-year-old neutered male domestic shorthair cat was referred with suspected uroperitoneum. Ultrasonography showed peritoneal effusion. CT further revealed a bilateral sacroiliac joint disruption associated with an overlapped dislocation of the pubic symphysis, resulting in an abnormal trajectory of the urethra with extramural urethral compression. An open reduction and internal fixation of the pubis with correction of the urethral trajectory was performed under general anaesthesia. The uroperitoneum was determined to originate from a cystocentesis.

Relevance and novel information

This report describes an unusual case of urethral obstruction secondary to overlapping dislocation of the pubic symphysis with urethral entrapment and concurrent bilateral sacroiliac luxation. To the authors' knowledge, acute urethral obstruction owing to fractures of the pubis, without urethral laceration, has never been described.

Percutaneous Treatment of Locked Pubic Symphysis with the Anterior Subcutaneous Pelvic Fixator (INFIX): A Case Report

CASE

A 54-year-old woman was involved in a motor vehicle collision and sustained a lateral compression type 1 pelvic ring fracture with pubic symphyseal dislocation or a "locked pubic symphysis." Her injury failed to reduce with closed reduction maneuvers under anesthesia and necessitated a percutaneous reduction using a distraction force applied through supra-acetabular placed pedicle screws. This anterior subcutaneous internal pelvic fixator (INFIX) was also used to stabilize the injury.

CONCLUSION

This is the first reported case where a locked pubic symphysis, which failed standard closed reduction measures, was reduced and stabilized through a percutaneous technique, using the INFIX.

Irreducible Overlapping Pubic Symphysis Dislocation Managed with Distraction Osteotomy of the Contralateral Superior Pubic Ramus: A Rare Case Report

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.

Mid-term follow-up of superior pubic ramus osteotomy in locked symphysis pubis with urethral injury: A case report

A locked pubic ramus body is an unusual variant of lateral compression injury. Till date, there have been only 25 cases reported in the published literature. We herein described 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.

Locked pubis symphysis in a skeletally immature patient, a case report

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.

Treatment of Locked Pubic Symphysis by Distraction Osteotomy of the Superior Pubic Ramus: A Case Report

CASE

An 18-year-old adolescent sustained a lateral compression injury to the pelvis that featured a locked pubic symphysis with plastic deformation of the sacrum. The pubic bone was entrapped in the opposite obturator foramen and required a novel distraction osteotomy of the superior ramus to restore the symphysis. The patient developed a urethral stricture 3 months after injury that required urethroplasty. The symphysis remained in alignment without any morbidity at the osteotomy site over 13 months of follow-up.

CONCLUSION

Locked pubic symphysis is frequently associated with urethral injuries. The distraction osteotomy of the superior pubic ramus described is a viable reduction maneuver that neutralizes the plastic deformation forces.

Locked book pubic symphysis: A case report in a resource-limited setting in sub-Sahara Africa

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Locked pubic symphysis is a serious injury of the pelvis.

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Very few cases has been reported in the literature.

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This nosological entity shows peculiarities in its manually difficult reduction and associated complications.

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A good outcome can be obtained after management with simple gestures, possible even in ressource-limited settings.

Introduction

Locked pubic symphysis is a rare but serious injury that occurs by lateral compression mechanism. It is an overlapping pubic symphysis dislocation, with one pubic bone entrapped behind the contralateral pubis, locked into the contralateral obturator foramen.

Case report

We report the case of a 25 years old male who presented with acute urine retention following a left lateral compression pelvic trauma by a motor vehicle and was diagnosed with a locked pubic symphysis treated successfully by open reduction and combined internal and external fixation.

Conclusion

Locked pelvic symphysis is a rare form of pelvic injury. The majority of cases require stabilization by open reduction and internal fixation of the anterior pelvic ring. Urogenital injuries are the commonest associated injuries, despite unfavourable mechanism.

Overlapping Dislocation of the Pubic Symphysis with an Open Reduction and Anterior and Posterior Pelvic Ring Fixation: A Case Report

CASE

We present a case of a patient who sustained overlapping dislocation of the pubic symphysis (ODPS), which required an open reduction as well as anterior and posterior pelvic ring fixation.

CONCLUSION

This case report is a valuable addition to the current literature on ODPS because we believe it to be the first report describing a patient who required both anterior and posterior fixation because of pelvic instability.

Locked pubic symphysis into the obturator foramen: a rare case presentation and literature review

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.