Is fixation failure after plate fixation of the symphysis pubis clinically important?
BACKGROUND
Plate fixation is a recognized treatment for pelvic ring injuries involving disruption of the pubic symphysis. Although fixation failure is well known, it is unclear whether early or late fixation failure is clinically important.


OBJECTIVE
We therefore determined (1) the incidence and mode of failure of anterior plate fixation for traumatic pubic symphysis disruption; (2) whether failure of fixation was associated with the types of pelvic ring injury or pelvic fixation used; (3) the complications, including the requirement for reoperation or hardware removal; and (4) whether radiographic followup of greater than 1 year alters subsequent management.


METHODS
We retrospectively reviewed 148 of 178 (83%) patients with traumatic symphysis pubis diastasis treated by plate fixation between 1994 and 2008. Routine radiographic review, pelvic fracture classification, method of fixation, incidence of fixation failure, timing and mode of failure, and the complications were recorded after a minimum followup of 12 months (mean, 45 months; range, 1-14 years).


RESULTS
Hardware breakage occurred in 63 patients (43%), of which 61 were asymptomatic. Breakage was not related to type of plate, fracture classification, or posterior pelvic fixation. Five patients (3%) required revision surgery for failure of fixation or symptomatic instability of the symphysis pubis, and seven patients (5%) had removal of hardware for other reasons, including late deep infection in three (2%). Routine radiographic screening as part of annual followup after 1 year did not alter management.


CONCLUSIONS
Our observations suggest the high rate of late fixation failure after plate fixation of the symphysis pubis is not clinically important.
Department of Trauma and Orthopaedics, Frenchay Hospital, North Bristol NHS Trust, Bristol, UK.
Stephen A C
SA
Morris
Jeremy
J
Loveridge
David K A
DK
Smart
Anthony J
AJ
Ward
Tim J S
TJ
Chesser
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D002648:Child; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011631:Pubic Symphysis / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D046548:Pubic Symphysis Diastasis / Q000453:epidemiology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult