Endoscopic-assisted osteosynthesis versus open reduction osteosynthesis of traumatic pubic symphysis diastasis: one year radiological and functional outcomes

Background: Traumatic pubic symphysis diastasis (TPSD) results from high-energy injuries and can lead to significant morbidity if managed improperly. Although open reduction osteosynthesis (ORO) is a well-established approach, it involves extensive soft tissue dissection. Endoscopic-assisted osteosynthesis (EAO) has emerged as a minimally invasive alternative. However, the advantages of EAO over ORO remain unclear. We aimed to investigate differences in perioperative details, functional outcomes, postoperative pain, and short-term radiological outcomes between EAO and ORO for TPSD management. Materials and Methods: We conducted a retrospective case-control study of 47 patients (mean age 34.8 years) with TPSD treated from January 2016 to January 2024 at a single institution. Of these, 14 and 33 patients underwent EAO and ORO, respectively. Demographic information, operative details, postoperative pain (visual analog scale), complication rates, radiological parameters (Matta/Tornetta criteria, Lefaivre criteria, and pubic symphysis distance), and functional outcomes (Majeed and Merle d’Aubigné scores) were analyzed. All patients were followed-up for ≥12 months. Results: EAO had a significantly longer surgery duration than ORO (201.8 vs. 128.2 min, p = 0.001) but demonstrated lower intraoperative blood loss (150.0 vs. 324.4 mL, p = 0.003) and lower postoperative visual analog scale pain scores (1.7 vs. 3.8, p = 0.001). Radiological assessments indicated no significant differences in the reduction quality or recurrent diastasis between the two groups. Although the EAO group showed significantly higher Majeed scores at 3 and 6 months, both groups had comparable functional outcomes at 12 months. Conclusions: Despite longer surgery duration, EAO offers advantages in terms of reduced blood loss and enhanced short-term functional recovery without compromising final radiological outcomes or increasing complications. Therefore, EAO is a viable and minimally invasive alternative for managing TPSD.