Crossing the symphysis: a novel percutaneous technique for fixation of the anterior pelvic ring

Percutaneous fixation of anterior pelvic ring injuries using a trans-symphyseal curved intramedullary implant offers a minimally invasive solution for challenging fracture patterns, particularly in patients with fragility fractures or compromised parasymphyseal bone. This technical report outlines key steps and intraoperative pearls for successful execution of the procedure, including fluoroscopic positioning, precise trajectory planning, safe passage across the pubic symphysis, and strategies to navigate the contralateral anterior osseous corridor. Techniques such as guide wire double-bending, cortical blocking wire placement, and elevator-assisted redirection are described in detail to address common challenges including narrow bony corridors and acute pelvic angulation. The described method avoids reliance on poor-quality ipsilateral bone and eliminates the need for extensive surgical exposure. Our early experience highlights the importance of attention to key anatomical landmarks, imaging guidance, and technical adaptability to ensure consistent implant passage, seating, and stability. This report serves as a guide for surgeons adopting the trans-symphyseal curved fixation approach.