Trans-obturator cable fixation of open book pelvic injuries.

Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.

[Outcome after plate stabilization of symphyseal diastasis]. / Ergebnisse nach Plattenstabilisierung der Symphysensprengung.

BACKGROUND: Separation of the pubic symphysis with corresponding diastasis can be stabilized by symphyseal plating. OBJECTIVE: Which pelvic injuries are stabilized with symphyseal plating and what is their outcome? MATERIAL AND METHODS: A retrospective evaluation of 64 patients who underwent symphyseal plating over a period of 24 months was conducted. RESULTS: Of the patients 56 were male and 8 female with a mean age of 44 years (SD ± 17 years). The main cause of the pelvic injuries were traffic accidents. The distribution according to the AO fracture classification was 14â€¯× B1, 10â€¯× B2, 5â€¯× B3, 23â€¯× C1, 9â€¯× C2 and 3â€¯× C3 injuries. The distribution according to the Young and Burgess classification showed 9â€¯× APC I, 18â€¯× APC II, 13â€¯× APC III, 9â€¯× LC I, 3â€¯× LC II, 2â€¯× LC III and 10â€¯× VS injuries. The mean Injury Severity Score (ISS) was 32 (SD ± 17) and the mean inpatient stay was 29 days (SD ± 16 days; positive correlation p ≤ 0.001). Radiological implant loosening occurred in 52 patients. 14 patients required treatment for severe complications. The leading reason for revision surgery was implant failure (n = 8). CONCLUSION: These observations suggest that radiological signs of implant loosening are commonly observed but rarely the reason for revision surgery. Complete implant failures, however; occur mainly within the first postoperative weeks and require early revision. A timely clarification by additional X-ray imaging should be carried out if this is suspected.