title: Radiographic changes of implant failure after plating for pubic symphysis diastasis: an underappreciated reality?
abstract: BACKGROUND
  Implant failure after symphyseal disruption and plating reportedly occurs in 0% to 21% of patients but the actual occurrence may be much more frequent and the characteristics of this failure have not been well described.
  
  
  OBJECTIVE
  We therefore determined the incidence and characterized radiographic implant failures in patients undergoing symphyseal plating after disruption of the pubic symphysis.
  
  
  METHODS
  We retrospectively reviewed 165 adult patients with Orthopaedic Trauma Association (OTA) 61-B (Tile B) or OTA 61-C (Tile C) pelvic injuries treated with symphyseal plating at two regional Level I and one Level II trauma centers. Immediate postoperative and latest followup anteroposterior radiographs were reviewed for implant loosening or breakage and for recurrent diastasis of the pubic symphysis. The minimum followup was 6 months (average, 12.2 months; range, 6-65 months).
  
  
  RESULTS
  Failure of fixation, including screw loosening or breakage of the symphyseal fixation, occurred in 95 of the 127 patients (75%), which resulted in widening of the pubic symphyseal space in 84 of those cases (88%) when compared with the immediate postoperative radiograph. The mean width of the pubic space measured 4.9 mm (range, 2-10 mm) on immediate postoperative radiographs; however, on the last radiographs, the mean was 8.4 mm (range, 3-21 mm), representing a 71% increase. In seven patients (6%), the symphysis widened 10 mm or more; however, only one of these patients required revision surgery.
  
  
  CONCLUSIONS
  Failure of fixation with recurrent widening of the pubic space can be expected after plating of the pubic symphysis for traumatic diastasis. Although widening may represent a benign condition as motion is restored to the pubic symphysis, patients should be counseled regarding a high risk of radiographic failure but a small likelihood of revision surgery.
  
  
  METHODS
  Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Harris Methodist Fort Worth Hospital and John Peter Smith Orthopaedic Surgery Residency Program, Fort Worth, TX 76104, USA. ccollinge@msn.com
authors.forename: Cory
authors.initials: C
authors.lastname: Collinge
authors.forename: Michael T
authors.initials: MT
authors.lastname: Archdeacon
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dulaney-Cripe
authors.forename: Berton R
authors.initials: BR
authors.lastname: Moed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017760:Bone Malalignment / Q000000981:diagnostic imaging / Q000601:surgery*; D001860:Bone Plates; D019544:Equipment Failure Analysis; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011475:Prosthesis Failure; D046548:Pubic Symphysis Diastasis / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult