THE RETROGRADE MEDULLARY SUPERIOR PUBIC RAMUS SCREW FOR THE TREATMENTOF ANTERIOR PELVIC RING DISRUPTIONS - A NEW TECHNIQUE

Retrograde medullary screws were used in 26 patients with unstable pel vic ring injuries to stabilize the superior pubic ramus fractures. The posterior pelvic ring fractures and dislocations were fixed with ilio sacral screws. The retrograde screws were inserted after closed manipu lative reductions of the superior pubic ramus fractures in 15 patients and after open reduction in nine patients. We were unable to insert t he screw in two patients due to anatomical variations. One screw was m isplaced superior to the pubic ramus and noted only on the postoperati ve computed tomography scan. Another patient experienced symptomatic s crew disengagement that required reoperation. All fractures healed and no infections developed. Blood loss was minimal for the percutaneous procedures. The technique provides stability to the anterior pelvic ri ng without the need for extensile surgical exposures. The complication s of both anterior pelvic external fixation and plating are avoided, y et this technique has its own potential problems. The procedure is des cribed in detail, and the early results and complications are document ed in our first 26 patients.