Internal fixation of symphyseal disruption resulting from childbirth.
OBJECTIVE
To investigate the clinical and radiographic results after operative treatment of complete symphyseal disruption resulting from childbirth and to evaluate residual pain and implant failure in relation to the timing of surgery.


METHODS
Retrospective study.


METHODS
Tertiary pelvis and acetabulum care unit at a general hospital.


METHODS
Ten consecutive women with complete symphysis disruption associated with childbirth were included from a database of 603 patients with pelvic fracture. No patients with this diagnosis were excluded. All patients were followed until clinical healing of the symphysis or union of the fusion.


METHODS
Open reduction and internal fixation in acute (less than 2 weeks from childbirth, four patients) and after failed nonoperative treatment in subacute cases (2 weeks to 6 months after childbirth, three patients). Fusion of the symphysis with iliac crest bone graft and plate fixation after failed nonoperative treatment in chronic cases (greater than 6 months, three patients).


METHODS
Analyzed variables included the Lindahl score, maintenance of postoperative reduction, implant failure, malunion, and necessity of reoperation.


RESULTS
Mean age of the patients was 32 years (range, 24-37 years). Mean follow up was 29 months (range, 5-139 months). The mean postoperative Lindahl score was 68 ± 14.6 points (range, 38-80 points). There were three excellent, four good, two fair, and one poor result. Fair or poor results occurred in one subacute and two chronic cases. There were two revision surgeries. One patient underwent implant removal resulting from dyspareunia 3.1 years postoperatively. One subacute patient had conversion to symphyseal fusion after implant failure as a result of a fall 11 years after index surgery. Major complications occurred in two and minor complications in three patients. Radiographic loosening of implants was observed in all subacute cases. All fusions healed and symptoms improved at last follow up.


CONCLUSIONS
Operative management significantly improved the functional outcomes of all three subgroups and can be an acceptable treatment option for labor-induced complete symphysis pubis disruption.
The Hip & Pelvis Institute, St. John's Health Center, Santa Monica, CA, USA.
Soheil
S
Najibi
Moritz
M
Tannast
Robert E
RE
Klenck
Joel M
JM
Matta
D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007743:Labor, Obstetric; D036801:Parturition; D011247:Pregnancy; D011630:Pubic Bone / Q000000981:diagnostic imaging / Q000601:surgery; D011631:Pubic Symphysis / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome