Pubic rami fractures are very common with anterior pelvic ring injuries.

Pubic bones fixation in the case of unstable pelvic ring fractures improves the outcome of clinical treatment.
Pubic bones fractures
Currently there are three major surgical techniques of pubic bones fixation. They include the Pelvic External Fixator application, minimally invasive osteosynthesis with cannulated screws, and finally, open reduction and internal plating.
Methods
1. Pelvic ExFix

2. IM Cannulated Screws

3. Plates
The most common technique of pubic bones fracture fixation is making use of the Pelvic Extérnal Fixator. But this method has its disadvantages. The Pelvic External Fixator is a bulky device which creates discomfort for a patient and makes care more difficult. The Pelvic External Fixator forces a patient to be in a supine position which can cause bed sores.
1. Pelvic ExFix
Also, there is the risk of pins migration, soft tissues inflammation in the application area along with Pelvic External Fixator failure. It can necessitate another surgery and Pelvic External Fixator reassembling. In 4 % of cases femoral cutaneous nerve damage , meralgia, can develop.
1. Pelvic ExFix
The second common technique is minimally invasive osteosynthesis with cannulated screws.
Per Nakatani classification, there are three zones where a pubic bone fracture can occur.
In Zone 1 fractures are medial with respect to the obturator ring. In Zone 3 fractures are lateral with respect to the obturator ring. Zone 2 fractures occur between the two.
2. Screws
Zones 1 and 2 fractures are best fixed with retrograde screws.
2.1. Retrograde screw
Zone 3 fractures are best fixed with antegrade screws.
2.2. Antegrade screw
However, in 15 % of cases we can encounter fixation loss and fixator migration. There is a possibility of femoral blood vessels and hip damage.
In some cases, the parabolic curvature of superior pubic ramus is so severity that long screw insertion is practically impossible. It reduces the biomechanical fixation stability.
Open reposition and internal osteosynthesis of pubic bone fractures require a vast surgical access area and involves comparatively significant blood loss.
3. Plates
With this approach, damage of vital organs such as arteries, veins and nerves is possible. The surgeon's anatomy expertise is an absolute must.
In 5 % of cases, infection can occur also. In this case the complication requires another hospitalization, fixator removal and conversion to the Pelvic External Fixator.
To help resolve these problems we have developed a simple, reliable and minimally invasive technique of pubic bones fracture fixation with an application of a blocking nail.
The key point of the technique is conducting a springy titanium nail through a 5 mm cutaneous puncture in the area of the symphysis.
Pu-Lock™
CONCLUSIONS
The proposed technique of osteosynthesis for pubic rami fractures is
Minimally invasive
A minimally invasive procedure that is associated with minimum blood loss and low risk of inflammation in the postoperative period.
Fastest patient activation
Fixation with this technique is characterized by sufficient biomechanical stability, allowing full support on the lower limb immediately after the surgery.
Simple
Using an interlocking nail, retrograde osteosynthesis of pubic rami fractures in all Nakatani zones with one incision and without the risk of damage to the hip joint is possible.
Without the risk of inflammatory complications
Moreover, the novel surgical technique could be used in patients with anterior abdominal wall wounds.
There is no necessity to remove fixators
Interlocking nailing for pubic rami fractures is a fixation method that does not require mandatory removal of the fixator after confirmation of healing.
Reliable
Healing of pubic rami fractures with this technique is similar to that in conventional techniques, and rapid achievement of good functional results could be expected.
Clinical Cases
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