OBJECTIVE: We present a case and provide an overview of the literature on rare pelvic girdle injury following spontaneous delivery with combined transsymphyseal and transiliosacral instability, its diagnosis and surgical treatment. CASE REPORT: Injury of the pelvic girdle during childbirth is one of the rare obstetric complications. Due to its low prevalence, the standard treatment algorithm is not defined. We present the case of a 27-year-old primipara with a combined separation of the symphysis and sacroiliac joint after spontaneous childbirth, which did not become clinically apparent until several hours later. After the assessment of clinical findings and results of imaging examinations, we indicated the patient for surgical revision due to significant pain syndrome and movement restrictions. Under general anesthesia, we reduced symphysis in an open manner and fixed it with a pelvic plate. We also fixed the injured sacroiliac joint after a closed reduction with a percutaneously inserted iliosacral screw. On the second postoperative day, the patient was mobilized on crutches. On the fourth postoperative day, the patient was discharged from the hospital. The patient was followed up at regular intervals postoperatively. One year after the injury, the pelvic girdle is clinically stable and the patient has no complaints. CONCLUSION: An injury of the pelvic girdle should be considered whenever postpartum patient complains of pain in the area of the symphysis or sacroiliacal joints after natural delivery. In such a case, after a basic imaging diagnosis, a consultation with a specialist with experience in the treatment of pelvic injuries is appropriate. When selecting the most appropriate surgical technique, the nature of injury itself and also early patient mobilisation to be able provide adequate care for her newborn, should be taken into account. Early surgical treatment using stable osteosynthesis helps to address this requirement.

• Klíčová slova
• combined transsymphyseal and transiliosacral instability, peripartal pubic symphysis separation, surgery,
• MeSH
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• pánevní kosti * MeSH
• sakroiliakální kloub diagnostické zobrazování   chirurgie   MeSH
• symphysis pubica * diagnostické zobrazování   chirurgie   MeSH
• těhotenství MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY The aim of this study is to evaluate the first experience gained with the new type of anatomical symphyseal plates intended to stabilise ruptured symphysis and closely located fractures. MATERIAL AND METHODS A retrospective evaluation was performed in 5 patients who had undergone surgery in the period from July 2015 to the end of 2016 using a new anatomical symphysial plate for pelvic ring injury. In four cases a stabilisation of symphyseolysis was carried out and in one case osteosynthesis of bilateral rami fracture near the symphysis was performed. The posterior pelvic segment was fixed 3 times by iliosacral screws and 2 times by a transsacral bar. All the surgeries in symphysis region were performed via a modified anterior suprapubic approach. A total of 3 men and 2 women with the mean age of 54.6 years (range 19-77 years) were operated. The mean follow-up period of five patients was 12.6 months. Also, preliminary evaluation of postoperative clinical and radiological outcomes was conducted on a very heterogenous group of patients. RESULTS The postoperative radiological outcome assessed by Pohlemann score was excellent in all the cases. After 3-6 months, screw loosening was reported in 3 cases, with no impact on the overall result of the surgery, in one case the symphysis widened 2 mm with simultaneous loosening of two screws, with no impact on the clinical result either. Clinical evaluation of the results was conducted in 4 patients using the Majeed score with the mean follow-up of 12.6 months, the score achieved was 98, 86, 72 and 49 points. In one patient the results could not be evaluated due to concurrent spinal cord injury with quadriplegia. Nonetheless, even this patient has no difficulty in sitting in a rehabilitation wheelchair. No serious intraoperative or early postoperative complications were reported. As regards late complications, one female colostomy patient developed deep infection three months after the primary surgery. DISCUSSION The first clinical as well as radiological outcomes in our small group of patients are comparable to the outcomes of larger groups using multi-hole plates to stabilise the anterior segment, or the application of 2 plates. In agreement with other authors, the new plates can be applied through a less invasive operative approach avoiding the necessity to transect rectus abdominis muscles. The results of earlier biomechanical studies suggest that their strength will equal 2 inserted plates, or will be comparable to multi-hole plates. CONCLUSIONS The first experience with the use of new anatomical symphysial plates are promising. The new types of plates intended for anterior pelvic segment facilitate fixation by screws inserted at two levels. They significantly improve the stability of fixation and can replace the commonly used 2 plates. The only limiting factor of our group of patients is its small size. Comparative weight-bearing tests shall be performed in the future. Key words:symphysis pubic disruption, pelvic ring fractures, pelvic instability, new symphyseal plates.

• MeSH
• fraktury kostí diagnóza   chirurgie   MeSH
• hodnocení výsledků zdravotní péče MeSH
• kostní destičky * MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• nestabilita kloubu * diagnóza   chirurgie   MeSH
• pánevní kosti diagnostické zobrazování   zranění   MeSH
• rentgendiagnostika metody   MeSH
• symphysis pubica * zranění   patofyziologie   chirurgie   MeSH
• vnitřní fixace fraktury * škodlivé účinky   přístrojové vybavení   metody   rehabilitace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH