Disjunction of the Pubic Symphysis in the Chu Gabriel Toure: Therapeutic Aspects

Abstract

Symphyseal dissection results from high-energy trauma and usually occurs in poly trauma context. The treatment is only orthopedic in our department. The aim of this work was to study the current therapeutic aspects management of the disjunction of the pubic symphysis in the department of ortho-traumatology of CHU Gabriel Touré of Bamako MALI. This was a prospective and analytical study; from 1 July 2021 to 30 June 2022, within 15 patients classified according to Young and Burgess, with a functional evaluation according to Majeed and a minimum follow-up of 4 months. We report symphyseal disconnections accounted for 20.83% of the traumas of the pelvic ring, and 1.84% of patients hospitalized for fracture in the department during the period of the study. We noted a predominance of gender male in 87% of cases with a ratio of 2.75 and the average age in our series was 32 years, with extremes ranging from 18 to 63 and a SD of 13.96. The most common etiologies are APR with 66.7% and traditional mine slide cases with 20%, and the anteroposterior compression mechanism is most frequently encountered at 73.3%. The APCI types: 20%, APCII: 40% and VC: 20% of the Young and Burgess classification are the most found. The treatment of these patients was surgical in 53% cases by locked screw plate. The surgical approach of Pfannenstiel was preferred to the ilio-inguinal of Judet. Non-surgical treatment by trans-osseous traction and the wearing of a pelvic belt was recommended for cases of stable disjunction or severe associated lesions. The average length of stay is 17.27 days with extremes of 5 and 34 days. The functional assessment according to Majeed allowed us to classify 73.3% of patients’ cases as excellent, showing a good socio-professional reintegration. Symphyseal disjunction is a rare pathology but of serious functional consequences, regardless of the therapeutic method good management allows to minimize these functional sequelae.