New Concealed-Incision Extrapelvic Approach for Pubic Symphysis Diastasis and Parasymphyseal Fractures: Preliminary Results

• Published in: Journal of bone and joint surgery. American volume Vol. 102; no. 17; p. 1542
• Main Authors: Liu, Songxiang, Xiao, Baojun, Liu, Ping, Wei, Youxiu, Liu, Yongwei, Fu, Dehao
• Format: Journal Article
• Language: English
• Published: United States 02.09.2020
• Subjects: Adult; Female; Fracture Fixation, Internal - methods; Fractures, Bone - complications; Fractures, Bone - surgery; Humans; Male; Middle Aged; Pubic Bone - injuries; Pubic Bone - surgery; Pubic Symphysis Diastasis - surgery; Retrospective Studies; Treatment Outcome; Young Adult
• ISSN: 1535-1386
• DOI: 10.2106/JBJS.19.01152

The Pfannenstiel approach, which provides good surgical exposure, has been used for the treatment of pubic symphysis diastasis and parasymphyseal fractures. However, it requires a medium-length incision and moderate soft-tissue dissection, resulting in potential damage to anatomical structures and inferior aesthetic outcomes. Here, we introduce a new concealed-incision extrapelvic approach for the internal fixation of pubic symphysis diastasis and parasymphyseal fractures. We retrospectively reviewed the records of 8 patients with pubic symphysis diastasis and parasymphyseal fractures that had been treated via the concealed-incision extrapelvic approach (the "Fu-Liu" approach). All patients presented for treatment during the period from January 2017 to November 2017. Six of the 8 patients had anterior column fractures, 1 patient had a double-column fracture, and 1 patient had parasymphyseal fractures. Operative time, the amount of blood loss, and postoperative radiographic and computed tomography (CT) findings were recorded. The degree of fracture-healing, complications, function, and satisfaction with the skin incisions were also evaluated. All patients were followed for at least 21 months (range, 21 to 30 months). Postoperative radiographs and CT scans showed good positioning of plates and screws. The average time before surgery, operative time, and intraoperative blood loss (and standard deviation) were 7.8 ± 3.25 days, 41.9 ± 8.99 minutes, and 18.8 ± 7.8 mL, respectively. No complications (including internal fixation failure, vascular injury, nerve palsy, wound infection, and hernia) occurred in any of the patients, and all patients were satisfied with the appearance of the scar. We can effectively stabilize pubic symphysis diastasis and parasymphyseal fractures with use of the Fu-Liu approach, which can also enable retrograde anterior column screw placement. The Fu-Liu approach is simple, safe, and minimally invasive, and the aesthetic outcome is more acceptable than that associated with the Pfannenstiel approach. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.