Case Report of Overlapping Pubic Symphysis Dislocation Managed Nonoperatively

Overlapping pubic symphysis dislocation (OPSD) is a rare form of pelvic injury typically caused by high-energy lateral compression forces, resulting in the entrapment of the pubic body against or behind the contralateral pubic ramus. The majority of reported cases have required open reduction and internal fixation due to the mechanical complexity of the injury. However, less invasive management strategies may be feasible in select cases. We present a case of a 56-year-old male with diabetes who sustained an OPSD associated with a right sacral ala fracture, along with multiple nondisplaced rib and lumbar spine fractures, following blunt trauma. Urological evaluation, including CT urogram and ascending urethrogram, confirmed no bladder or urethral injury. Given the absence of posterior instability and urethral injury, this specific patient was managed conservatively under general anesthesia with fluoroscopic guidance. Manual reduction was successfully performed using a flexion, abduction, and external rotation maneuver of both hips, with anterior pressure on the symphysis. The patient was instructed to perform non-weight-bearing mobilization for six weeks, followed by gradual mobilization. Follow-up imaging confirmed a maintained reduction without signs of pelvic instability or urological complications. This case demonstrates that closed manual reduction can be a viable alternative to surgical intervention in selected cases of OPSD, particularly when there is no associated urethral injury or complex posterior pelvic ring disruption. Early recognition, appropriate imaging, skilled reduction under anesthesia, and maintained reduction at 18 weeks with no complications are critical in achieving favorable outcomes while minimizing surgical morbidity.