Symphysiodesis with silver-coated plates for the treatment of traumatic symphyseal instability in complex pelvic trauma

Background: Pelvic ring fractures represent a challenging injury pattern, particularly when accompanied by abdominal trauma and soft tissue disruption, increasing the risk of fracture-related infection (FRI). This report highlights the role of silver-coated implants in the staged management of a complex pelvic injury complicated by abdominal infection for prevention of FRI. Clinical case: A 55-year-old male sustained a bilateral Type C pelvic ring fracture and multiple associated intraabdominal injuries following high-energy trauma. Initial management included C-clamp stabilization, laparotomy, and urogenital reconstruction. Due to severe abdominal soft tissue infection, a staged fixation strategy was applied: minimally invasive posterior ring fixation and temporary anterior external fixation. After abdominal infection control, a xenogenic mesh was used to reconstruct the abdominal wall. Secondary, symphysiodesis was indicated due to persistent instability of the symphysis. The procedure was ultimately performed using autologous bone graft and double plating with silver-coated implants. Results: Initially, the patient sustained multiple infectious complications, including bacteremia and urogenital infections, requiring prolonged antimicrobial therapy. At long-term follow-up, a stable fusion of the symphysis was achieved without further infection or mechanical complication. Conclusion: This case demonstrates that silver-coated implants can serve as an effective adjunct in managing pelvic injury patients at high-risk for infection.