These implant failures are the main reasons for revision surgery and may be linked to the rigid character of the fixation technique 9. Other disadvantages of plating include hardware breakage or implant loosening, which lead to recurrent instability of the pubic diastasis. From the healing perspective, the currently preferred treatment is not the ideal one as it does not provide a dynamic fixation 8 and the plate is placed in an unfavorable rectangular position to the load vectors that affect the ruptured symphysis. The pubic symphysis comprises a fibrocartilaginous disc between the articular surfaces of the pubic bones, encapsulated and reinforced by surrounding ligaments allowing limited movement 7. This plate fixation, however represents a static fixation of what is actually a dynamic junction. Currently, symphyseal plating represents the most common technique for anterior pelvic ring fixation in such conditions 6. Adequate reduction and stable fixation can restore pelvic ring alignment and allow early patient mobilization 5. When diastasis of the disrupted symphysis pubis exceeds a certain displacement, stabilization of the anterior pelvic ring is recommended 3, 4. The disruption of the anterior pelvic ring might occur in combination with a posterior pelvic ring impairment of variable severity. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.ĭisruption of the pubic symphysis is commonly seen in pelvic ring injuries of trauma patients 1, 2. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. 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. A cadaver study was carried out to analyze the trans-obturator surgical approach. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. 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. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment.
Trans-obturator cable fixation might be a more reliable technique however, have not yet been tested for stabilization of ruptured pubic symphysis. Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications.
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