gms | German Medical Science

Objectives: A 40-year old male sustained a Type C pelvic ring injury with bilateral disruption of the iliosacral joints, comminuted fracture of the right pubic rami and symphyseal diastasis. The pelvic ring was fixed anteriorly with a 3.5 low profile plate over a Stoppa approach and posteriorly with two 3.5 reconstruction plates over bilateral anterolateral approaches. Postoperative recovery was uneventful with good clinical outcome. The plate showed signs of breakage on follow-up X-ray 1 year postoperatively. 3 years later the patient suddenly complained about increasing low abdominal pain and haematuria without any history of recent trauma. The abdomen was soft with tenderness above the symphysis. Blood samples were normal. X-ray examination of the abdomen revealed partial loosening of one of the right-sided symphyseal screws with protrusion into the small pelvis. On CT-scan 2cm of the screw were found to be located inside the bladder.

Methods: The patient underwent cystotomy and bladder repair over the previous Stoppa approach. The screw was extracted through the bladder and complete implant removal of the anterior pelvic ring was performed. The postoperative course was uneventful.

Results and conclusion: Hardware failure such as screw migration or plate breakage is a well-known complication after ORIF of the anterior pelvic ring. Screw migration into hollow visceral organs is extremely rare. A review of the literature shows only 3 similar cases; in all of them spontaneous urinary voiding of screws occurred. In conclusion, regular radiological follow-up examinations after symphyseal plating are indicated particularly if hardware failure is noticed. The role of implant removal remains controversial.