Rajput Rakesh, Pal Kunal Kanti, Goel Ajay Kumar, Mandal Ananda
Department of Orthopaedics, The Calcutta Medical Research Institute (CMRI), Kolkata, West Bengal, India.
J Orthop Case Rep. 2021 Jul;11(7):53-56. doi: 10.13107/jocr.2021.v11.i07.2314.
Overlapping pubic symphysis dislocation (OPSD) or a locked pubic symphysis is a compression of the pelvic ring with the intact pubis trapped into the contralateral obturator foramen. Reduction can be difficult and contralateral suprapubic osteotomy is a good way to address the irreducible OPSD. The technique has only been discussed thrice in the available literature.
We report the case of a 26-year-old man who had his right pubic ramus entrapped within the contralateral obturator foramen, having an overlap of >4 cm with associated ipsilateral sacroiliac joint (SI joint) disruption and urethral injury. When all the maneuvers of closed and instrumented open reduction failed, we performed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus. The osteotomy site was stabilized with a 6-hole recon plate and SI joint was stabilized with a 6.5mm percutaneous sacroiliac screw. The patient underwent delayed urethral repair at 10 weeks after the index surgery. At 3-year follow-up, the patient did not report any pubic discomfort, urinary and sexual problems.
Locked OPSD is a rare injury and is frequently associated with sacroiliac and urethral injuries. Distraction osteotomy of the contralateral superior pubic ramus is a viable option for irreducible cases.
耻骨联合重叠脱位（OPSD）或耻骨联合绞锁是一种骨盆环压缩损伤，完整的耻骨被困于对侧闭孔内。复位可能困难，对侧耻骨上支截骨术是处理不可复位的OPSD的一种好方法。该技术在现有文献中仅被讨论过三次。
我们报告一例26岁男性病例，其右侧耻骨支被困于对侧闭孔内，重叠超过4厘米，伴有同侧骶髂关节（SI关节）脱位和尿道损伤。当所有闭合复位和器械辅助切开复位操作均失败后，我们在左侧实施了耻骨上支截骨术，解除了嵌顿的右侧耻骨支。截骨部位用一块6孔重建钢板固定，SI关节用一枚6.5毫米经皮骶髂螺钉固定。患者在初次手术后10周接受了延迟尿道修复术。在3年随访时，患者未报告任何耻骨不适、泌尿和性功能问题。
耻骨联合绞锁是一种罕见损伤，常与骶髂关节和尿道损伤相关。对侧耻骨上支撑开截骨术是不可复位病例的一种可行选择。
