The retrograde medullary superior pubic ramus screw for the treatment of anterior pelvic ring disruptions: a new technique.

Retrograde medullary screws were used in 26 patients with unstable pelvic ring injuries to stabilize the superior public ramus fractures. The posterior pelvic ring fractures and dislocations were fixed with iliosacral screws. The retrograde screws were inserted after closed manipulative reductions of the superior pubic ramus fractures in 15 patients and after open reduction in nine patients. We were unable to insert the screw in two patients due to anatomical variations. One screw was misplaced superior to the pubic ramus and noted only on the postoperative computed tomography scan. Another patient experienced symptomatic screw disengagement that required reoperation. All fractures healed and no infections developed. Blood loss was minimal for the percutaneous procedures. The technique provides stability to the anterior pelvic ring without the need for extensile surgical exposures. The complications of both anterior pelvic external fixation and plating are avoided, yet this technique has its own potential problems. The procedure is described in detail, and the early results and complications are documented in our first 26 patients.