Pubic symphysis fixation is an operation to stabilise a disrupted pubic symphysis — the joint at the front of the pelvis where the two pubic bones meet. It is performed for traumatic pelvic ring injuries where the symphysis is widened or disrupted.
An incision is made in the lower abdomen (Pfannenstiel incision, similar to a caesarean section). The disrupted symphysis is exposed. The pubic bones are reduced (brought back together) and fixed with a plate and screws across the symphysis. The operation takes one to one and a half hours. It is often combined with posterior pelvic ring fixation.
Pubic symphysis fixation is required when the symphysis is widened by more than 2.5 cm in the context of an unstable pelvic ring injury (APC type II or III). Isolated symphysis widening without posterior ring injury (APC type I) is usually managed without surgery.
Stable pelvic injuries with less than 2.5 cm symphysis widening may be managed with restricted weight-bearing.
CT scan of the pelvis. Assessment of posterior ring injury. May require emergency pelvic binder or external fixation first.
Restoration of anterior pelvic ring stability. Combined with posterior fixation, restores overall pelvic stability for weight-bearing.
Low transverse abdominal scar.
The plate may be palpable over the pubic symphysis.
Bone formation around the symphysis.
The plate may break or screws pull out, particularly if the posterior ring is not adequately stabilised.
The bladder lies directly behind the symphysis.
Pubic symphysis injuries may affect sexual function.
Wound infection.
The symphysis may re-widen.
General anaesthesia.
Weight-bearing restrictions for six to twelve weeks depending on posterior ring stability. Physiotherapy for core and pelvic strengthening. Full recovery six to twelve months.
X-rays at six weeks and three months.
Not usually. If the plate causes irritation (e.g., during sit-ups or with pressure), removal can be considered after healing.