Retrograde transpubic screw fixation of transpubic instabilities.

OBJECTIVE: Reduction and retention of unstable and/or severely displaced fractures of the upper pubic ramus with an associated risk of injury to the pelvic organs with transpubic screw fixation. Restoration of form and function of the pelvis. INDICATIONS: Injuries to the pelvic ring with displaced and/or unstable fractures of the upper pubic ramus. Stabilization of the anterior column of the acetabulum in isolated fractures of the anterior column. Additional internal fixation as part of the management of acetabular fractures with transverse components, combined with stabilization of the posterior column. CONTRAINDICATIONS: Poor general health, local soft-tissue injury. SURGICAL TECHNIQUE: Pfannenstiel's incision to achieve open reduction and screw fixation of the pubic ramus under image intensification. POSTOPERATIVE MANAGEMENT: Depending on the general condition of the patient and pelvic ring stability, mobilization on forearm crutches with partial weight bearing (one fifth of body weight) of the side with injury to the posterior pelvic ring.
RESULTS: Transpubic screw fixation was performed in 16 patients with displaced fractures of the upper pubic ramus as part of pelvic ring injuries (twice type A, six times type B, eight times type C). Intraoperative complications were not observed. Postoperative complications occurred in two cases (one rectus hernia, one screw pullout with manifestation of chronic osteomyelitis of the pubic ramus). All other fractures healed within 3 months.