Symphysiodesis

Symphysiodesis is a surgical procedure that fuses the pubic symphysis, the cartilaginous joint connecting the left and right pubic bones. The operation is performed to stabilize the pelvis when the symphysis has become unstable or painful. It is commonly indicated after severe traumatic pelvic fractures, such as combined pelvic ring injuries, or in cases of chronic pubic symphyseal dysfunction that have failed conservative treatment. Other circumstances include specific forms of chronic pelvic pain, ankylosing spondylitis when the sacroiliac joints are involved, or obstetric complications such as persistent pain after a prolonged prolonged labor. The fusion may also be considered as a treatment option for specific pelvic floor disorders that cannot be managed with less invasive therapies.

The most common surgical approaches involve an open transpubic approach, a posterior bucco‑incisional approach, or a minimally invasive laparoscopy‑assisted method. In the open technique, an incision is made over the symphysis, the joint is prepared by removing cartilage and underlying bone, and plating or interpositional bone graft material is applied to promote osseous fusion. Laparoscopic techniques involve establishment of pneumoperitoneum and transperitoneal placement of plates through small port sites. In some cases, an endoscopic approach is used for partial fixation. Materials used for grafting include autograft bone from the iliac crest, allograft, and synthetic bone substitutes. Implantation of a rigid metal plate can assist in immediate stability, although the plate is eventually absorbed as the bone fuses.

Post‑operative recovery generally requires a period of pelvic rest and limited weight bearing, coupled with graded physical therapy to restore motion and strength. Fusion typically occurs within 8–12 weeks, after which the patient can resume normal activities. Complications may include infection, hardware failure, non‑union or mal‑union, injury to surrounding nerves or vessels, and persistent pain. Long‑term studies indicate satisfactory outcomes in most patients, particularly when the procedure is staged after initial fracture fixation and when meticulous surgical technique is observed.