Master the surgical treatment of "open book" type pelvic ring injury, an opening of the pubic symphysis. This training offers practical immersion in reduction and anterior fixation, covering everything from patient positioning and surgical access, with attention to the bladder, to the use of temporary screws for controlled reduction and the application of plates for definitive fixation, aiming for pelvic ring stability and early rehabilitation.

Training Focus:

• Treatment of "open book" pelvic ring injury (pubic symphysis dislocation).
• Reduction and anterior fixation of the pubic symphysis.
• Surgical access with bladder protection.
• Use of temporary screws for controlled reduction.
• Application of plates for definitive fixation.
• Pelvic ring stability and early rehabilitation.

Detailed Content:

• Positioning and Access: Position the patient in dorsal decubitus for free access of the image intensifier. Perform an incision approximately 2 cm superior to the pubic symphysis, exposing the rectus femoris fascia and the linea alba. Make a longitudinal incision in the linea alba and locate the pubic tubercle.
• Exposure and Preparation: Protect the bladder (previously emptied) with a malleable retractor. Dissect the periosteum of the symphysis to create space for the plate. Identify the symphysis opening and, if necessary, clean any fibrosis. Position a Hohmann retractor in the obturator foramen for exposure.
• Provisional Reduction: Use temporary screws, one on each side of the symphysis, inserted from anterior to posterior with precise measurement. Employ a specific clamp coupled to these screws for reduction and adjustment, visually controlling shear and opening.
• Definitive Fixation: With reduction maintained, use a specific plate for the symphysis with screw insertion at a 30-degree angle. If non-locked screws are not firm, add a second locked plate anteriorly for greater stability.
• Closure and Verification: Do not approach the sacroiliac joint if the posterior ligaments are intact.  Reinsert the rectus abdominis tendon and close the linea alba to prevent herniation. Continuously protect the bladder. Close the skin guided by dermographic markings for aesthetics.

Included Material:

• Detailed PDF: Covers patient positioning, surgical access, exposure of the pubic symphysis, provisional reduction with screws and specific clamp, definitive fixation with plates, verification of posterior stability, and closure.
• Also includes a practical summary of the procedure with key points.

Enhance your skills in pelvic surgery. Enroll now and master the techniques for reduction and anterior fixation of the pubic symphysis, ensuring pelvic ring stability and early rehabilitation for your patients.