From the Guidelines
Pubic shear injuries with significant displacement (greater than 2.5 cm) require surgical intervention to stabilize the pelvis using plates, screws, or external fixation devices, as recommended by the World Society of Emergency Surgery (WSES) classification and guidelines 1. The treatment of pubic shear injuries depends on the severity of the injury, with mild to moderate cases often managed with pain management, rest, and limited weight-bearing using crutches or a walker. However, for more severe cases with significant displacement, surgical intervention is necessary to achieve anatomic reduction and stable fixation, which is a prerequisite for early functional rehabilitation 1. Some key points to consider in the management of pubic shear injuries include:
- The use of computed tomography (CT) scans with 3-Dimensional bone reconstruction to evaluate the extent of the injury and plan surgical management 1
- The importance of evaluating for associated injuries, such as urethral injuries, which can be diagnosed using retrograde urethrogram (RUG) or late contrast CT-scan with a urologic study 1
- The need for careful examination of the ano-rectal region to detect blood, rectal wall weakness, and non-palpable prostate, with rigid proctoscopy considered in cases of positive rectal examination 1
- The goal of treatment is to restore the mechanical stability of the pelvic ring, allowing for early functional rehabilitation and reducing the risk of long-term complications such as chronic pain or gait abnormalities 1. In cases of hemodynamically stable and mechanically unstable patients with no other lesions requiring treatment and a negative CT-scan, definitive mechanical stabilization can be performed directly 1.
From the Research
Pubic Shear Overview
- Pubic shear, also known as pubic symphysis diastasis, refers to a condition where the pubic symphysis, a cartilaginous joint located between the two pubic bones, is disrupted or separated 2, 3.
- This condition can be caused by various factors, including trauma, pregnancy, and parturition, and can lead to significant pain and disability 3, 4.
Diagnosis and Treatment
- Diagnosis of pubic shear can be made through physical examination, imaging studies such as X-rays and CT scans, and provocative maneuvers 2, 4.
- Treatment options for pubic shear include conservative management with pain management and mobilization, as well as surgical intervention with internal fixation, bone grafting, or symphyseal arthrodesis 2, 4.
- The use of locking plates has been shown to be a safe and effective treatment option for pubic symphysis diastasis, with low complication rates and good outcomes 2.
Associated Conditions and Complications
- Pubic shear can be associated with other conditions, such as osteitis pubis, insufficiency fractures, and chronic anterior pelvic instability 4.
- Complications of pubic shear can include chronic pain, disability, and limited mobility, as well as potential long-term consequences such as degenerative changes and nonhealing fractures 3, 4.
- The degree of patient disability after pubic shear can vary greatly, and no clinical factors or diagnostic studies can effectively predict the course of patient recovery 3.