Clinical and radiological outcomes for percutaneous reduction and fixation of symphyseal diastasis

PURPOSE: Symphysis pubis diastasis constitutes 13% to 16% of pelvic ring disruptions. The conventional standard procedure for treating symphysis diastasis is symphyseal plating using a Pfannenstiel approach. Recently, percutaneous techniques have been applied to manage a variety of acetabular and pelvic injuries. The study aims to evaluate the clinical and radiological outcomes of treating symphysis pubis diastasis using percutaneous screws. METHODS: This prospective study was conducted at a level I trauma university center from September 2020 to July 2022. Twenty patients with symphyseal diastasis were included. Two partially cancellous screws 7.3 mm in size were used for percutaneous fixation of all cases with symphysis pubis diastasis. Posterior pelvic injuries were fixed based on the existing pathology. Symphysis pubis distance was measured in millimeters on preoperative, immediate postoperative, and the last follow-up visit using anteroposterior plain radiographs of the pelvis. All patients had a minimum of 1 year of follow-up. Clinical evaluation was done at the last follow-up using the visual analogue scale to assess pain at the symphysis pubis, while functional evaluation was done using the Majeed grading method. RESULTS: The injury patterns included AO/OTA 61C1.3 (n = 8), 5 AO/OTA 61C1.2 (n = 5), AO/OTA 61C1.1 (n = 3), and AO/OTA 61B1.2 (n = 4). According to the Majeed scoring system, 15 patients had excellent scores, 4 had good scores, and 1 had poor scores. The mean preoperative symphyseal distance was 3.3 cm, the mean immediate distance was 0.42 cm, and the mean distance at 1-year follow-up was 0.65 cm. CONCLUSION: Percutaneous fixation of the symphysis pubis showed favorable results with acceptable clinical and radiological outcomes. It is a safe technique, but it requires technical expertise.