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Tips for the surgical repair of a pelvic symphysis separation

This technique is a simple and easy method of stabilizing the pelvic symphysis.

Pubic portion repair

  • With the patient in dorsal recumbency, identify the pubic tubercle.

  • Make a longitudinal incision over the pubic tubercle and blunt dissect through soft tissue to expose the tubercle portion of each pubic bone.

  • Reflect a small portion of muscle adjacent to the tubercle area to expose a suitable portion of each pubic bone to take a drill hole.

  • Drill a hole [2mm for the Size 1 Han-de toggle] through each pubic bone.

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  • Now change your surgical gloves. Open two Han-de ligatures and move the toggle up the ligature.

  • Place a Han-de toggle in each hole, push the toggles into the pelvic space and pull the ligatures tight to lock the toggles onto the inner surface of the bone. Then pull each strand individually to eliminate any ligature loops on the toggle side.

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  • If you attempt to use only one Han-de ligature, by placing one toggle of the device in each hole, you may find that, in the live patient, the ligature does not run freely through the toggles. Thus the assembly cannot be tightened.

  • Using the ligatures, pull the pubic bones into normal position and tie the ligatures to secure the repair.

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Ischial portion repair

  • The surgical approach to the ischium is simple and quick.

  • Aim to expose the caudal edge of the ischial bones.


  • Incise the edge of the internal obturator muscle as close as possible to the ischium.

  • Lift the internal obturator muscle by blunt dissection to expose the flat surface of the ischium. This dissection protects all nerves and vessels in that area.
  • Expose the ischial bones on both sides.

  • Drill a hole  [2mm in diameter for the Size 1 Han-de toggle] in each ischial bone close to the symphysis.

  • Use a drill sleeve and try to drill as perpendicular to the bone surface as possible. Take care not to penetrate too deep into the soft tissue below the ischium.

  • Take a large semi-circular suture needle and thread two loops of strong suture material through the eye; one loop in one direction and the other loop in the opposite direction.

  • Clamp the needle in a strong needle holder. Pass the blunt, eye-end of the needle under the muscles of the genital / urinary organs. Keep the needle as close as possible to the bone surface. It helps to feel, with your finger tip, for the blunt end of the needle as it comes through from one side to the other.

  • Lay out the two loops of suture material; one loop each side.

  • Open two Han-de ligatures and place a toggle and ligature in each drill hole.

  • Using the end of the loop passer, push the toggle to the underside of the ischium. The direction of push needs to be at the same angle as the drill hole.


  • Pull both ligature strands of each toggle to lock the toggle onto the bone. Then pull each strand individually to eliminate any ligature loops on the toggle side.

  • Thread one strand of ligature from each side through the preplaced loop on that side and pull to the other side.

  • Pull the ischial bones together using the ligatures. Tie one side and then the other to complete the pelvic symphysis repair

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