Retrograde transpubic screw fixation of transpubic instabilities.
OBJECTIVE
Reduction and retention of unstable and/or severely displaced fractures of the upper pubic ramus with an associated risk of injury to the pelvic organs with transpubic screw fixation. Restoration of form and function of the pelvis.


METHODS
Injuries to the pelvic ring with displaced and/or unstable fractures of the upper pubic ramus. Stabilization of the anterior column of the acetabulum in isolated fractures of the anterior column. Additional internal fixation as part of the management of acetabular fractures with transverse components, combined with stabilization of the posterior column.


METHODS
Poor general health, local soft-tissue injury.


METHODS
Pfannenstiel's incision to achieve open reduction and screw fixation of the pubic ramus under image intensification.


METHODS
Depending on the general condition of the patient and pelvic ring stability, mobilization on forearm crutches with partial weight bearing (one fifth of body weight) of the side with injury to the posterior pelvic ring.


RESULTS
Transpubic screw fixation was performed in 16 patients with displaced fractures of the upper pubic ramus as part of pelvic ring injuries (twice type A, six times type B, eight times type C). Intraoperative complications were not observed. Postoperative complications occurred in two cases (one rectus hernia, one screw pullout with manifestation of chronic osteomyelitis of the pubic ramus). All other fractures healed within 3 months.
Gänsslen
Axel
A
Unfallchirurgische Klinik, Medizinische Hochschule Hannover. gaensslen.axel@mh-hannover.de
Krettek
Christian
C
D000063:Accidents, Traffic; D000077:Acetabulum / Q000293:injuries / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D017102:Fracture Healing; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery; D011182:Postoperative Care; D011183:Postoperative Complications; D011300:Preoperative Care; D011630:Pubic Bone / Q000293:injuries / Q000601:surgery; D012421:Rupture; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014521:Urethra / Q000293:injuries* / Q000601:surgery; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery