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External fixation
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Open reduction and internal fixation of the pubic symphysis with a two-hole plate
Open reduction and internal fixation of the pubic symphysis with a two-hole plate and posterior triangular osteosynthesis
Open reduction and internal fixation of the pubic symphysis with a multi-hole plate
Open reduction and internal fixation of the pubic symphysis with a multi-hole plate and posterior plate osteosynthesis
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The patient has sustained an anterior posterior compression (APC) grade II pelvic ring injury. Initial management should consist of pelvic volume reduction with pelvic binding or sheeting. Once the patient is hemodynamically stable, the decision for definitive management should be made. In a retrospective review of more than 200 patients, Sagi and Papp investigated plate osteosynthesis of the pubic symphysis. They found significantly fewer malunions in the multi-hole plate group and a trend toward fewer surgeries in the same group. Typically external fixation should be reserved for temporary fixation and not a definitive management in stable patients. Posterior fixation is reserved for injuries with disruption of the posterior ligamentous constraints, typically APC grade III injuries. Triangular osteosynthesis is a strategy for fixation of unstable vertical shear fractures that require fixation of the pelvis to the lumbar spine.
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