Year: 2026 | Month: March | Volume: 13 | Issue: 3 | Pages: 451-458
DOI: https://doi.org/10.52403/ijrr.20260351
Widened Pubic Rami in Bladder Exstrophy-Epispadias Complex (BEEC): A Rare Case Report and Surgical Considerations
Anak Agung Gde Radityaningrat1, Seva Ajisma1, Gede Mahardika Putra2
1Resident of Orthopaedic and Traumatology, Prof Ngoerah General Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
2Department of Orthopaedic and Traumatology, Prof Ngoerah General Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
Corresponding Author: Anak Agung Gde Radityaningrat
ABSTRACT
Bladder exstrophy is a rare congenital anomaly characterized by extrusion of the urinary bladder through a lower abdominal wall defect and is frequently associated with pelvic musculoskeletal deformities. One important abnormality is widening and malalignment of the pubic rami, which complicates reconstruction and requires multidisciplinary management. We report a 6‑month‑old male infant with two months of hematuria and a congenital suprapubic bulge with a reddish mass. Clinical and radiological evaluation confirmed bladder exstrophy. Pelvic radiographs showed widened, malaligned pubic rami with separation at the symphysis pubis. The patient underwent multidisciplinary surgery involving urologists, orthopedic surgeons, and plastic surgeons. The orthopedic team performed bilateral Salter innominate osteotomies to mobilize the iliac wings, followed by pubic symphysis reduction using the Müller technique and fixation with Vicryl 1 sutures. Bilateral Schanz screws and an external pelvic fixator with backslab were applied to maintain stability. Postoperatively, vascular and neurological status remained normal, with good hip, knee, and ankle range of motion. This case illustrates the importance of early orthopedic intervention in correcting pelvic deformity in bladder exstrophy. Bilateral Salter osteotomies enable medial rotation of the iliac bones, facilitating pubic approximation and contributing to pelvic ring stability when combined with soft tissue and urological reconstruction. Bladder exstrophy with pubic diastasis requires coordinated multidisciplinary care, and timely orthopedic procedures are crucial to support structural reconstruction and optimize functional outcomes in these rare, complex congenital cases.
Keywords: Widened Pubic Rami, Bladder Exstrophy-Epispadias Complex, bilateral Salter osteotomy
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