Title : Unusual presentation of pubic symphysis diastasis secondary to high-energy trauma in a polytraumatized pediatric patient
Abstract:
Introduction: Pubic symphysis diastasis is an extremely rare injury in the pediatric and adolescent population, primarily due to the high inherent elasticity of the ligamentous complexes and the significant energy-absorbing capacity of the developing pelvic cartilage. Its anatomical presence is a direct indicator of a massive biomechanical energy transfer mechanism, which usually coexists with severe, life-threatening multisystemic injuries.
Objective and Justification: The main objective of this report is to document this rare lesional association to alert medical personnel about "diagnostic distraction bias." Innovating in the comprehensive approach to the neurocritical patient implies recognizing that the clinical severity of a severe traumatic brain injury (TBI) often overshadows underlying pelvic orthopedic injuries, which remain clinically silent due to the patient's state of unconsciousness. This case strongly justifies the need to protocolize systematic pelvic radiological screening in patients exposed to high-impact kinematics, regardless of the initial neurological priority.
Case Description: We present the case of a previously healthy 16-year-old male patient who was admitted for severe polytrauma after a motorcycle accident. Upon admission, he presented moderate to severe TBI associated with fractures of the skull base and temporal bone, right parietal epidural hematoma, left subdural hemorrhage, and severe cerebral edema with ventricular collapse. He received conservative medical management and neuroprotective strategies in the pediatric intensive care unit. He showed a highly favorable neurological evolution without requiring cranial surgical intervention. Simultaneously, as an injury associated with the same high-energy impact, a diastasis of the pubic symphysis was identified. This pelvic condition was thoroughly evaluated and managed jointly by the traumatology and orthopedics service. After achieving clinical and hemodynamic stability, the patient was discharged with a multidisciplinary outpatient follow-up plan.
Conclusions: Pubic diastasis in pediatric patients represents a genuine diagnostic challenge. Success in its clinical resolution lies in maintaining a high index of early clinical suspicion and executing an integrated management plan that resolves the primary neurocritical emergency without neglecting pelvic orthopedic stabilization, thereby preventing long-term functional complications.
