MTOS – Fractures – ORIF for pubis symphysis diastasis

Ligamentous structure
．Sup and inf pubic ligament
．Arcuate ligament

Indication :
．Diastasis > 2.5 cm (Tile B or C)
．Pain relief and stability of anterior pelvic ring
．Tile B: intact posterior pelvic ligament
．Diastasis: associated sacrospinous and anterior sacroiliac ligament rupture

Contraindication
．Critically ill, unstable patient`
．Open fracture with contaminated wound
．Skin compromise
．Suprapubic pouch (catheter)

Pfannenstiel incision
．Slightly curved incision above pubic symphysis
．For OB/GYN surgery
．Bikini line
．Linea alba: longitudinal splitting
．Detach linea alba: if failed reduction

Fixation methods
．reconstruction plate, 2 hole each side
．4.5mm Screw direction: A – P

Complication
．Loss of fixation: physiological motion in pubic symphysis, inadequate posterior fixation
．Impotence: due to initial injury