Patterns of surgical complications after delayed fixation of peripartum pubic symphysis rupture: a report of 5 cases.

BACKGROUND: The disruption of the pubic symphysis during the peripartum period is a rare injury to the pelvic ring. In most cases, conservative treatment is successful. Nonetheless, there are cases where surgical intervention is necessary. We analyzed five surgical cases treated in our department and performed a literature review. CASE PRESENTATIONS: Five women, ranging in age from 25 to 38, who experienced peripartum symphysis rupture were primarily treated with a conservative approach. Patients who did not show improvement and met certain criteria, such as experiencing pain starting from childbirth, having a separation in the pubic bone of more than 10 mm, and/or having a vertical instability greater than 5 mm, were recommended to undergo surgery. The average length of time between childbirth and surgery was 5.6 months, ranging from 1 to 14 months. One patient was treated with an external fixator, another patient received a combination of an external fixator and an anterior plate, and three patients were treated with anterior plates. In four cases, we observed a failure in fixation and a partial or complete loss of reduction. The plate and screws were removed in one case, and in three cases, revision surgery was performed. One case involved using a larger plate, while the other used 90-90 plating, known as "box plate fixation." The mean follow-up was 7.4 years. Two cases had good results, and two had excellent results on the Lindahl scale. CONCLUSION: For patients with peripartum pubic symphyseal dislocation, our case series and literature review demonstrated that early reduction and fixation correlate with improved clinical outcomes and lower implant failure. For patients with subacute/chronic injuries, there was a higher incidence of implant failure. Orthogonal plate fixation and/or pubic symphysiodesis was associated with improved clinical outcomes.

Surgical treatment outcome evaluation of hip joint acetabular fracture.

Since November 1989 till the end of 2007 year we have been operatively treating 752 of acetabular hip fractures. We have analised 750 operated patients, two patients bilateral fractures. The follow up span lasts from 2 till 20 years. The age of treated patients is from 14 till 79 years old. These fractures were divided into those operated to 21 days after trauma--569 operated acetabulum. And those operated after 21 days after trauma--183 patients with the delayed reconstruction of acetabular fractures from 22 till 229 days. Both groups were provided detailed assesement. And next we compared fracture reduction of broken acetabulum and assesement of clinical treatment. The types of fractures were defined according to classification of Judet-Letournel. The criteria of fracture reduction due to Letournel. The clinical result was based on Merle d'Aubigne-Matta scale. In the group of treated patients till 3 weeks after trauma, we have received 83.8% of very good and good results, 6.9% fair results and 9.3% poor results. During fracture reduction: 75% very good, 4% in secondary joint congruence, 17.8% fair and 3.2% poor. After fair reduction there was always the right congrugence between the head and acetabulum. The displacements to 3 mm were left in more cases as a part after weight-bearing area. In trauma fracture trated after 3 weeks, the result was very good and good 66.1%, fair 14.8% and poor 19.1%. During fracture reduction: 49.7% very good, 4.4% secondary joint congruence, 32.8% fair and 13.1% poor. We have noticed the crucial corelation between fracture reduction and the final result of treatment. Additional traumae, especially head with long time loss of consciousness and the traumae of chest with insufficient breathing have indirect infulence on treatment results causing the longer operation waiting. The complexity fractures also indirectly influence on the result of treatment decreasing the chances on anathomical fracture reduction.

Open reduction and internal stabilization of acetabular fractures in pregnancy--case report.

Pelvic and acetabular fractures are common injuries in the time of rising traffic level and often affect young people, that's why this kind of injury during pregnancy must be considered. Despite lapse of years this subject is seldom raised in literature. Conservative treatment was usually recommended. We came across a single case report of surgical treatment of acetabular fracture during pregnancy, it was 18th week of pregnancy at the moment of accident. The aim of this study is detailed description of surgical treatment of hip joint acetabular fracture with fragment dislocation of 29 years old female at 27th week of pregnancy. Patient was involved in road accident, car passenger, she suffered: transverse fracture of the hip acetabulum with central dislocation of the femoral head, left distal radius fracture, head injury with concussion, numerous face injuries. Patient was treated surgically in 15 day after accident: open reposition and synthesis of a fracture. Course of operation as planed. Patient was discharged and advised to walk with crutches. Patient delivered healthy child by caesarean section at full-term afterwards. The outcome of acetabular fracture treatment was very good (18 points on a scale Merle d'Aubigne-Matta).