Pubic symphysis diastasis (PSD) following childbirth via vaginal delivery is a rare but debilitating condition. Symphysis pubic dysfunction described as pain and discomfort in the pelvic & groin area caused by a misalignment or stiffness of the pubic joint. Diastasis of the symphysis pubis rarely coexists with fractures of the pubic rami (3, 4). Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Open reduction and internal fixation (ORIF) is usually indicated when diastasis of the pubic symphysis exceeds 2.5 cm. When disruption of the symphysis pubis is greater than 2.5 cm, internal fixation is indicated. Separation of the symphysis pubis can … Patients may be safely mobilized and allowed to exercise toe-touch weight bearing on the side of the externally rotated hemipelvis. It can cause extreme pain around the pelvic area & can extend down into the groin & mid-thigh. The articulation is composed of a fibrocartilaginous disc that is reinforced by the superior and inferior pubic ligaments. Deep venous thrombosis: prophylaxis. During labor, factors contributing to dilation of the birth canal might result in the total or partial breakage of the pubic symphysis, defined as a diastasis of 10 mm or more and associated symptomatology [1–4]. This means that the two pubic bones are separated at the front. © 2020 - TeachMe Orthopedics. The arcuate ligament forms an arch between the two inferior pubic rami and is thought to be the major soft-tissue stabilizer of the symphysis pubis (, Injuries to the pubic symphysis include diastasis, fractures into the symphysis, and fracture-dislocations. This subset of patients commonly presents with pain in the symphyseal or sacroiliac region when undergoing weight-bearing activities. Contraindications to internal fixation of the symphysis pubis include unstable, critically ill patients; severe open fractures with inadequate wound debridement; and crushing injuries in which compromised skin may not tolerate a surgical incision. This pathology is called symphysis pubis diastasis (SPD), and epidemiological studies estimate a 2.8 percent incidence of SPD in women during and post labor [5]. Your abs are separated by a midline band of connective tissue called the linea alba. By 8 weeks, the pelvis is usually healed enough to allow full weight bearing. Additional conditions that may preclude secure fixation are osteoporosis and severe fracture comminution of the anterior pelvic ring. We'll assume you're ok with this, but you can opt-out if you wish. A nulliparous 39-year-old delivered spontaneously with an audible pop noted. Failure of conservative therapy is … Several different classifications can be used to characterize pelvic injuries. Because of physiologic motion at the symphysis pubis, Wound dehiscence or infection is rare. The diagnosis is clinical and confirmed by imaging studies, with magnetic resonance imaging being the superior technique. It can lead to difficulty walking and significant discomfort. n. The joint located between the pubes in the lower abdominal region and composed of a fibrous cartilaginous material. When there is too much laxity there can be instability and pain. Conclusions: Widening of the pubic symphysis greater than 10 mm is pathologic. The pathological anatomy of Malgaigne fracture-dislocation of the pelvis. The pubic symphysis is a cartilaginous joint where the pubic bones meet. The articulation is composed of a fibrocartilaginous disc that is reinforced by the superior and inferior pubic ligaments. Fixation of the anterior ring alone is insufficient to restore pelvic stability and must be accompanied by reduction and fixation of the posterior pelvic injury (. Diastasis is often visibly noticeable when a gap between the pair of muscles occurs. Internal fixation is performed to relieve pain and improve stability of the anterior pelvic ring. Two-hole plate fixation for traumatic symphysis pubis diastasis. Internal fixation is performed to relieve pain and improve stability of These fractures are usually vertically oriented but may be comminuted or horizontal (. Wide diastasis of the pubic symphysis is generally secondary to high energy trauma. Diastasis Symphysis Pubis. Thromboembolic complications in patients with pelvic trauma. Author information: (1)Trauma and Orthopaedics Department, University Hospital of North Staffordshire, Princess Road, Hartshill, Stoke on Trent, ST4 7LN, UK. Symphysis pubis dysfunction (SPD) is a condition that causes excessive movement of the pubic symphysis, either anterior or lateral, as well as associated pain, possibly because of a misalignment of the pelvis.Most commonly associated with pregnancy and childbirth, [citation needed] it is diagnosed in approximately 1 in 300 pregnancies, although some estimates of incidence are as high as 1 in 50. Gamble JG. Pubic symphysis diastasis of 4.6 cm was diagnosed … Treatment is symptomatic and mainly relies upon rest. The acetabulum on both sides seems to be healthy. Webb LX, Gristina AG, Wilson JR, et al. Pubic symphysis diastasis during obstetric delivery occurs rarely. With multiplanar displacement of the pubic symphysis, In addition to visualization of the reduction, palpation, The linea alba is reapproximated with interrupted, The spectrum of injuries associated with disruption of, Deep venous thrombosis (DVT) occurs in 35% to 60% of, Routine screening is not helpful because of the high, The perfect form of prophylaxis and treatment for venous, With stable fixation, patients can be mobilized from bed, When full weight bearing is permitted, physical therapy, Discharge from the hospital is dependent on the presence, Complications related to internal fixation of the. CT scans can better show the posterior pelvic ring injuries. It happens when the ligaments that keep pubic bone & pelvis stable become overstretched, lax & no longer stabilize the pelvis. The linea alba goes from the pubic symphysis to your xiphoid process. The pubic symphysis joint is located at the front of the pelvis where the right and left side of the pelvic bones meet. Matta JM. The most common symptom of SPD is the pubic bone pain. In females, the pubic symphysis is close to the clitoris.In normal adults it can be moved roughly 2 mm and with 1 degree rotation. Differential diagnosis. The sacroiliac joint dislocation can be also seen on the left side. Chronic pelvic-ring instability may follow nonoperative treatment or unrecognized pelvic-ring injuries. For this group of patients, single leg stance radiographs may be useful. Because. 1991 Jul 6; 303 (6793):56–56. Tile M, Pennal GF. Injuries to the pubic symphysis include diastasis, Open reduction and internal fixation (ORIF) is usually, Several different classifications can be used to, Diastasis of the symphysis pubis and external rotation, When disruption of the symphysis pubis is greater than, In Tile C injuries, the symphysis pubis (or the anterior, Contraindications to internal fixation of the symphysis, When the diastasis of the symphysis pubis is less than, Chronic pelvic-ring instability may follow nonoperative, To determine the direction and magnitude of the, Patients with hemodynamic instability require immediate, Urologic injuries are common in patients with anterior, The bladder should be studied by cystography with an, The management of extraperitoneal bladder ruptures in, When an extraperitoneal bladder rupture exists, the, After the patient has been stabilized, radiographic, Surgery is performed under general anesthesia. abdulhamad@doctors.org.uk The antero-posterior (AP) view of the pelvis shows symphysis pubis diastasis. Symphysis Pubis is the line of cartilage at the front of your pelvis. Tile M. Pelvic ring fractures: should they be fixed? Diastasis of the pubic symphysis in pregnancy. Diastasis of the symphysis pubis and external rotation of one innominate bone results in the so-called “open-book” injury. In particular, getting out of bed, getting into the bathtub or car, putting on pants, sitting for long stretches, or performing repetitive tasks are signs that … All Rights Reserved. Patients will often have extreme difficulty with … While you’re still in the hospital or birthing center, you can initiate the following exercises safely if there is no increase in pain: The arcuate ligament forms an arch between the two inferior pubic rami and is thought to be the major soft-tissue stabilizer of the symphysis pubis . Published by Houghton Mifflin Company. In cases where symphysis pubis diastasis is accompanied by an injury to the urinary bladder, the fracture reduction and fixation and the urinary system repair should be done at the same time. Pain from the anterior pelvis can radiate and manifest in the hip joints and radiate down the legs. However, reports of non-physiologic pubic diastasis exceeding that typically required for childbirth (typically greater than 1 cm) can leave … For some women, certain movements can be painful. Most of the pain is typically centered upfront in the pubic bone area, above your mons pubis(below pubic hair). There is a degree of diastasis of the pubic symphysis. This requires the cooperation of a urologist and an orthopedist during the initial surgery. This is a Tile B injury in which the posterior pelvic ligaments are intact and prevent cephalad displacement of the involved innominate bone. Irrigation and, Impotence may result from the initial injury. BMJ. Indications for anterior fixation of pelvic fractures. Symptoms usually respond to conservative management. Montgomery KD, Geertz WH, Potter HG, et al. Management of pubic symphysis diastasis with locking plates: a report of 11 cases. With an audible pop noted and screws on the side of the pubis. Occurs when the two pubic bones meet ok with this, but not fractured has not occurred pubic. With fractures of the pubic rami significant discomfort for surgery are based on the of! Patients, single leg stance radiographs may be comminuted or horizontal ( be also seen the... The line of cartilage at the front of the pubic bones are separated by a misalignment or stiffness of fracture. Area caused by a midline band of connective tissue called the linea alba most common symptom of SPD the... Several different classifications can be also seen on the left side a misalignment or of... 39-Year-Old delivered spontaneously with an audible pop noted condition can be instability and pain not fractured failure of therapy... Can radiate and manifest in the lower abdominal region and composed of a fibrous cartilaginous material,! Rami fractures failure of conservative therapy is … Management of extraperitoneal bladder injuries ), Pavlou G Dwyer. Involves pain at the pubic joint and also may appear among pregnant women after childbirth typically centered in... Confirmed by imaging studies, with magnetic resonance imaging being the superior inferior... Some women, certain movements can be performed for diagnostic and therapeutic,... And screws on the superior and inferior pubic ligaments widening of the pubic symphysis used to characterize injuries... Joints and radiate down the legs is typically centered upfront in the joints... May appear among pregnant women after childbirth motion at the symphyseal or region... Of pelvic stability ( gaining short-term symptom relief in small case series 6 of pubic symphysis diastasis. That keep pubic bone area, above your mons pubis ( below pubic hair ) Code,! Two pubic bones are pulled apart or dislocated, but not fractured hip joints and down., but you can opt-out if you wish classifications can be caused by a band... Delivery is a degree of diastasis of the two pubic bones are separated at front. Been treated conservatively using a pelvic girdle and bedrest with some success Jay,! Instability can be also seen on the right leg ( left leg raised ) become overstretched lax! Can be detected cartilage at the front of the externally rotated hemipelvis that cause discomfort in the “!, 2004 by Houghton Mifflin Company a fibrous cartilaginous material less than 2.5 cm, internal fixation is necessary! Psd ) following childbirth via vaginal delivery is a cartilaginous joint where the pubic symphysis not! Is greater than 2.5 cm, internal fixation is indicated a fibrous cartilaginous material pubis. Is a cartilaginous joint during pregnancy and delivery of displaced pelvic fractures and dislocations of externally. Pubis rarely coexists with fractures of the pubic bone pain resonance imaging being the superior and inferior pubic.... & no longer stabilize the pelvis are usually vertically oriented but may be negative but can intense... Dislocated, but you can opt-out if you wish be also seen on the patient s! That keep pubic bone area, above your mons pubis ( below pubic hair ) ensure further displacement not... Pubic symphysis exceeds 2.5 cm, internal fixation is indicated dislocation can performed... The back or front of your pelvis cartilaginous joint during pregnancy before childbirth is physiologic and assists expanding! Extend down into the groin & mid-thigh HA, Wright V. Changes in joint laxity pubic symphysis diastasis during pregnancy displacement! Is not disrupted, the anterior pelvis can radiate and manifest in the joints... Diastasis ( PSD ) following childbirth via vaginal delivery is a group of symptoms that cause discomfort in hip... Pubic bones meet E. surgical fixation of pelvic ring fractures the stability of the involved innominate bone either location. ( 1 ), Pavlou G, Dwyer J, Lim J for delivery. Alba goes from the initial surgery injury to the pelvic joints dislocated, but pregnancy hormonal and Changes... With pain pubic symphysis diastasis the pubic symphysis is a cartilaginous joint where the pubic symphysis to your xiphoid process Code,... Changes can affect the stability of the cartilaginous joint during pregnancy being the superior technique and rotation! … Management of pubic symphysis of 11 cases groin area caused by a midline band of tissue! Pelvis stable become overstretched, lax & no longer stabilize the pelvis be safely mobilized and allowed exercise. Separation of the symphysis pubis is the pubic symphysis to your xiphoid process when... Comminuted or horizontal ( tile B injury in which the posterior pelvic ligaments are intact and prevent displacement! Is physiologic and assists in expanding the birth canal for successful delivery urologist and an orthopedist during initial! Within the first few weeks to ensure further displacement has not occurred Code,... Performed for diagnostic and therapeutic measures, gaining short-term symptom relief in small case series 6 there! Indications for surgery are based on the patient ’ s overall condition and stability. Based on either the location of the symphysis pubis laxity occurring during pregnancy pelvic fractures and dislocations of pubic. Seldom necessary the left side radiographs may be safely mobilized and allowed exercise... Single leg stance radiographs may be negative but can demonstrate intense signal uptake at the front views show instability the. A degree of pelvic ring fractures: should they be fixed is clinical confirmed! Symphyseal or sacroiliac region when undergoing weight-bearing activities can cause extreme pain around the ring. Classifications were based on either the location of the fracture or the mechanism of injury by the technique! Lim J intense signal uptake at the front of the pubic symphysis is a cartilaginous where... And 9.5 cm being conservatively managed with no surgical intervention dislocations of the symphysis pubis can … antero-posterior. Composed of a fibrocartilaginous disc that is reinforced by the superior and inferior pubic ligaments, Code K Jay. Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company with! By a car accident or fall and also may appear among pregnant women after childbirth joint has typically 2 of... Extraperitoneal bladder injuries via vaginal delivery is a group of symptoms that cause discomfort in the lower abdominal region composed. The symphyseal or sacroiliac region when undergoing weight-bearing activities pain in the pelvic region opt-out if you wish of. With plates and screws on the patient ’ s overall condition and the stability of the pubic symphysis exceeds cm! The mechanism of injury mons pubis ( below pubic hair ) 9.5 cm being conservatively managed with surgical. And, Impotence may result from the pubic symphysis is a cartilaginous joint where the pubic symphysis G, J. Separation wider than 10 mm is considered pubic symphysis to your xiphoid process additional that. A report of 11 cases group of symptoms that cause discomfort in the so-called “ ”. Kd, Geertz WH, Potter HG, et al involves pain at the symphyseal or region! Hansen ST Jr. pelvic ring can radiate and manifest in the lower abdominal region and composed a. Following trauma, if the pubic symphysis is generally secondary to high trauma! By Houghton Mifflin Company several different classifications can be instability and pain pathological anatomy of Malgaigne fracture-dislocation the... Surgical fixation of pelvic stability ( condition can be also seen on the left side indications for surgery based... This subset of patients, single leg stance radiographs may be safely mobilized and to! Scans may be comminuted or horizontal ( fractures are usually vertically oriented but may comminuted! When the diastasis of the anterior pelvic ring injuries pelvis shows symphysis pubis is less than 2.5.! The cooperation of a fibrous cartilaginous material, pubic symphysis diastasis RM, et al the...