Pubic Symphysis Disruption

Abstract

A 7-year-old male hit by a car while on a bicycle presented with multiple injuries including closed head injury, bilateral pulmonary contusions, pelvic ring injury, and right femur shaft fracture. The child was hemodynamically unstable with widening of the symphysis pubis and left sacroiliac joint disruption. The pelvis fracture protocol was initiated. Hemodynamic stability was obtained after sheeting of the pelvis and volume resuscitation including packed red blood cells. The patient underwent damage control temporary stabilization with external fixation of the pelvis and femur shaft fractures due to severe closed head injury and bilateral pulmonary contusions. Once the patient stabilized hemodynamically, definitive fixation of the pelvis was discussed including use of nonabsorbable suture fixation for the symphysis disruption versus plate and screw construct. Open reduction and internal fixation (ORIF) of the symphysis with plate and screws was selected given the left hemipelvic instability with left sacroiliac (SI) screw fixation performed to address the left SI joint disruption. He remained nonweight-bearing on his left lower extremity for 10 weeks postoperatively. At 3 month follow up, the pubic symphysis disruption and pelvic ring injury had healed with good pelvic symmetry and no pain with activities. Given the patient’s age and level of skeletal maturity, elective hardware removal will occur 1 year postoperatively.