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Symphyseal plating for pelvic fracture in a morbidly obese patient: operative challenges and innovation of a novel ‘wire-ramp plate-sliding method’
  1. Kumar Keshav,
  2. Manjunath Nishani,
  3. Amarendra Singh and
  4. Abhishek Singh
  1. Orthopaedics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  1. Correspondence to Dr Kumar Keshav; keshav4700{at}


We are describing a case report of a morbidly obese patient (body mass index 41) in his mid-40s with Young and Burgess Anteroposterior Compression type II injury (AO Foundation/Orthopaedic Trauma Association type B1.2) managed by symphyseal plating. Morbid obesity made working at a depth very difficult; hence, we adopted a novel ‘wire-ramp plate-sliding method’. In this method, two strong sturdy K-wires inserted through the medial-most plate holes into the pubis acted as a ramp over which the plate was pushed/slid distally. During this manoeuvre, the K-wires passing through the plate holes were used as a reduction tool. The patient also had a wedge fracture of the distal femoral shaft which was managed by retrograde femoral nailing. At 1-year follow-up, the pelvic continuity is maintained and the fracture has united. The patient is able to do full weight-bearing and is back to his normal life.

  • Orthopaedics
  • Orthopaedic and trauma surgery
  • Trauma

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigating results, drawing original diagrams and algorithms, and critical revision for important intellectual content—KK, MN, AmS and AbS. The following authors gave final approval of the manuscript—KK, MN, AmS and AbS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.