What is Pubic Symphysis? Definition, Anatomy, Diastasis

DEFINITION Illustration 1 for What is Pubic Symphysis? Essential Definition & Implications | Illustration 5 for What is Pubic Symphysis? Essential Definition & Implications

Illustration 23 for What is Pubic Symphysis? Essential Definition & Implications

Illustration 25 for What is Pubic Symphysis? Essential Definition & Implications

Illustration 30 for What is Pubic Symphysis? Essential Definition & Implications

FIG 2•Examples of the anatomic variants between genders. The female pelvis has a more concave shape to the ring and the pubic arch has less of an acute
angle because of the broader pubic body, as demon- strated in the inlet (A) and outlet (B) views of a fe-
male pelvis. The male pelvic ring is more oval, with a much more acute angle anteriorly because of the
thinner pubic body, as seen the corresponding inlet
C D
rotating on the intact posterior sacroiliac ligaments and cre-
ating an unstable pelvis (FIG 3).4
Illustration 35 for What is Pubic Symphysis? Essential Definition & Implications

Illustration 35 for What is Pubic Symphysis? Essential Definition & Implications

Illustration 41 for What is Pubic Symphysis? Essential Definition & Implications

Illustration 60 for What is Pubic Symphysis? Essential Definition & Implications

Illustration 63 for What is Pubic Symphysis? Essential Definition & Implications

A B C TECH FIG 1•A.The skin is marked for the incision. The entire lower abdomen is prepared, to include the umbili- cus and both anterior superior iliac spines as well as the anterior inferior iliac spines bilaterally. An incision is marked about two fingerbreadths superiorly to the pubic bones. B.The linea alba is clearly identified once the subcuta- neous fat has been dissected away from the fascia. An incision along the linea alba, between the two rectus mus- cles, is made to allow exposure of the space of Retzius. C.Once the space of Retzius is exposed, a dever or blunt re- tractor is used to retract the bladder and two Hohmann retractors are placed on the outside of each superior rami to expose the superior aspect and allow reduction and plating.
| WEBER CLAMP REDUCTION ■Once the superior aspect of the symphyseal bodies is ex- posed, the Weber clamp is placed anteriorly to avoid re-
moving the insertion of the rectus (TECH FIG 2A). ■The goal in using this technique is to have the tips of the Weber clamp at the same level on each symphyseal body. | ■ If anterior displacement is present on either side, the tip
of the clamp is placed slightly anterior on that side so at
the time of reduction the tips are at the same level.4 ■The clamp is tilted distally to engage the tines (TECH FIG 2B). ■The clamp is placed anterior to the rectus insertions.
محجوز: TECHNIQUES

tally will help engage the tines.

USE OF A C-CLAMP TO AID IN REDUCTION ■The C-clamp has been described for use in unstable APC
pelvic fractures in patients requiring an exploratory la-
parotomy or as temporary pelvic fixation if the patient
cannot go to the operating room. It can also be used to
assist in the open reduction of the symphysis if conven-
tional clamps cannot hold the reduction. ■This is a similar concept to the one described by Wright
et al for assisting in the reduction of the posterior pelvic
ring.17 ■To apply the C-clamp, the pins are placed two finger-
breadths directly posterior to the anterior superior iliac
spine. This places the pins in the gluteus pillar, a thick-
ened portion of the lateral ilium above the acetabulum
(TECH FIG 3A). A B C TECH FIG 3•Placement of pins for the C-clamp (A) and how it is applied to obtain a reduction of the symphysis (B,C).
Illustration 83 for What is Pubic Symphysis? Essential Definition & Implications

Illustration 83 for What is Pubic Symphysis? Essential Definition & Implications

JUNGABLUTH CLAMP REDUCTION (TECHNIQUE OF MATTA)

■ Jungabluth clamp reduction is used when the innomi-
nate bone is intact and the posterior ring is unstable. ■The innominate bone tends to be externally rotated, pos-
teriorly displaced, and superiorly translated. If this is the
case or vertical instability exists, the entire innominate
bone needs to be manipulated to obtain a reduction. ■ In these cases, the use of the Jungabluth clamp may
be necessary to achieve reduction. ■Drill holes are made in an anterior-to-posterior direction
for the placement for 4.5-mm screws. ■ For the screw being placed on the unstable side (with posterior displacement), a 4.5-mm gliding hole is drilled | and the screw is secured to the bone through a small
plate on the posterior side of the pubis using a nut (TECH
FIG 4A,B). ■The plate will act as a washer and provides a larger
surface area of force to be exerted on the hemipelvis
so one does not have to rely on the pullout strength
of a single screw. ■The Jungabluth clamp is then placed anteriorly and se-
cured to the 4.5-mm screws and can then be used to
achieve the reduction (TECH FIG 4C,D).5
A B C D TECH FIG 4•The Jungabluth clamp can be used to reduce the symphysis if there is posterior translation of the hemipelvis and intact innominate bone. A,B.On the side of the displacement, a screw is placed with a small plate attached with a nut so the plate acts a washer. C,D.The clamp is then attached to the head of the screw and is used to pull the hemipelvis forward to reduce the symphysis. A gliding hole must be used so the clamp pulls through the plate and does not rely on the pullout strength of a single screw. (Adapted from Matta JM, Tornetta P. Internal fixation of pelvic fractures. Clin Orthop Relat Res 1996;329:129–140.)
Illustration 97 for What is Pubic Symphysis? Essential Definition & Implications

Illustration 97 for What is Pubic Symphysis? Essential Definition & Implications

Pelvic Ring Fractures: Your Guide to Diagnosis, Treatment & Recovery

What is Pubic Symphysis? Essential Definition & Implications

Key Takeaway

You Might Also Like

Pelvic Discontinuity: Understanding Superior and Inferior Separation

Fixing Posterior Pelvic Ring Instability: Sacrum & SI Joint ORIF

Chapter Index