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1;AP X-RAY DEMONSTRATING APC TYPE 2
SYMPHYSEAL SEPARATION;INLET VIEW DEMONSTRATING
SEPARATION OF THE SYMPHYSIS;OUTLET VIEW;The patient is prepped, such that the symphysis
is exposed inferiorly, the umbilicus superiorly and
the ASIS laterally.;The incision begins two finger breadths
above the symphysis pubis.;The incision begins two finger breadths
above the symphysis pubis.;Frequently, one of the rectus heads is avulsed from
one of the symphyseal bodies. Occasionally there is
a split in the rectus fascia.;Gelpi retractors are placed at the wound edges to
help identify Scarpa’s fascia and then the external
oblique and rectus fascia.;The soft tissue is elevated superiorly and inferiorly
from the external oblique and rectus fascia with
the knife held essentially parallel with the body.;;The linea alba is easily identified by observing the
confluence of the fibers of the external oblique in the
midline.;The dotted line is placed on the linea alba; the
fascia between the two rectus muscles is divided
sharply but only through the fascia.;FOOT;HEAD;HEAD;FOOT;FOOT;;;;;;After the clamp is engaged, the symphysis is reduced
using the clamp. The clamp must be leaned towards
the feet in order to fully engage the tongs.;DEMONSTRATION OF THE
REDUCED SYMPHYSIS PUBIS;If a standard 6-hole curved plate is used, a downward bend is
essential at the outer aspect of the plate as the middle
two screws on each side go into the symphyseal body while
the last screw goes into the ramus, lateral to
the pubic tubercle.;The plate is also contoured in order to fit the bend of the
pelvis, which in men is usually an increased bend and in
women, a slight opening of the plate.;;The first screw that is placed is left somewhat proud
so as not to pull the plate over while the second screw
is placed in a similar fashion eccentrically in the hole.;The two screws are then tightened together,
allowing compression of the symphysis.;Anatomic reduction of the symphysis is achieved
and all the
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