Delayed migration of orthopedic screw into the bladder following pelvic fracture fixation

Migration of orthopedic screws into the bladder is a rare postoperative complication following surgical fixation of pelvic fractures. We present a case of a 61-year-old man who sustained a type 3 anteroposterior compression injury with pubic symphysis diastasis, left sacroiliac joint dislocation, and lumbar spine transverse process fracture. At the time of presentation open-reduction internal fixation of his pubic symphysis and closed-reduction percutaneous screw fixation of the left sacroiliac joint was performed. At his 6 month post operative visit, the patient was seen for follow up and reported mild pelvic pain and new urinary symptoms, including hematuria and recurrent urinary tract infections, which lead to further investigation. Imaging revealed findings concerning for migration of one of the pubic symphysis screws with bladder involvement. Cystoscopy confirmed the presence of a foreign body in the bladder. The patient subsequently underwent removal of the pelvic hardware, definitive bladder repair and left sacroiliac arthrodesis, followed by an uneventful postoperative course. This report describes the delayed presentation of spontaneous screw migration after repair of an open book pelvic fracture and describes the diagnostic and management considerations for patients with urinary symptoms after pubic symphysis open reduction internal fixation.