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Superior Pubic Ramus Osteotomy to Treat Locked Pubic SymphysisA Case Report
Robert V. O'Toole, MD1; Carlos Sagebien, MD2; Romney C. Andersen, MD3; Jason W. Nascone, MD1
1 Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 Greene Street, Baltimore, MD 21201. E-mail address for R.V. O'Toole: rvo3@yahoo.com
2 Department of Orthopaedics, Robert Wood Johnson Medical School, 215 Easton Avenue, New Brunswick, NJ 08901
3 Department of Orthopaedics, National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889
The Journal of Bone & Joint Surgery.  2006; 88:1609-1614  doi:10.2106/JBJS.D.02990
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Extract

Pelvic ring disruption that results in a locked pubic symphysis is an unusual injury. A locked pubic symphysis is defined as a compression of the pelvic ring, with the intact pubis becoming trapped against the contralateral pubis. Although the injury pattern is well recognized in clinical practice, to the best of our knowledge, only eight patients with this injury have been reported in the English-language literature1-8 since its original description by Eggers in 19523.A proposed mechanism for a locked symphysis is forced hyperextension and adduction of the hip1 resulting from a lateral compression force to the pelvis. This injury causes a rupture of the ligaments that normally stabilize the symphysis. The superior, anterior, and posterior ligaments are weak, while the arcuate (or inferior) ligament is thought to confer most of the stability to this fibrocartilaginous joint9. After rupture of these ligaments, the displaced pelvic bone may lie either anterior or posterior to the contralateral pubis. Because of the direction and magnitude of this pubic displacement, the injury pattern has been associated with urethral injury2,3,5,7.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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