Interlocking intramedullary nailing for pubic rami fractures

Unstable lateral compression pelvic fracture (video1) AO / OTA 2018 61B2.2af tilt-fracture (LC2) fracture of the right lateral sacrum mass. Ipsilateral fragmentary fracture of the right pubic bone (Nakatani I and III) with significant displacement, fracture of the right sciatic bone with displacement. Contusion and ecchymosis of the soft tissues of the anterior abdominal wall, scrotum and penis.

After admition the pelvis was stabilized with supraacetabular Ex-Fix.

On the 6th day when the patient had become stable, the ex-fix was removed and the definitive osteosynthesis of the pelvis was performed. Since the closed reduction of the pubic bone fragments was unsuccessful, an open reduction of the fracture in 1st zone according to Nakatani was performed through the extra-pelvical approach to the symphysis (6 cm) developed by us. After that, osteosynthesis of the pubic bone with a locked nail in zones I and III according to Nakatani was performed. Then, percutaneous fixation of the sacrum with a cannulated screw was performed at the S1 level.

Stability of the fixation was confirmed by means of a lateral compression stress test. One day after the surgery the patient still was in ICU, but could independently turn on his side already.

On the 5th day, the patient could sit on the bed and could stand on both legs. He was discharged for rehabilitation on the 14th day from the moment of injury.

12 months after the injury, complete recovery of the function was observed. Postoperative scar without any features, atrophic. Complaints of minor pain in the groin area on the right after long walks. On the radiograms fracture union of the anterior and posterior parts of the pelvis was observed.