Locked (Overlapping) Pubic Symphysis, an Uncommon Pelvic Ring Injury, Following High-Energy Crush Trauma: A Case Report.

Complex polytrauma resulting from high-energy trauma may necessitate interdisciplinary care. A rare pelvic injury called locked (overlapping) pubic symphysis is commonly linked to unstable pelvic ring disruption and frequently necessitates surgery. A 25-year-old man sustained a high-energy crush injury after a large rock fell onto him. The patient presented to King Hussein Medical City Emergency Department on February 5, 2026. After initial assessment, imaging demonstrated a locked pubic symphysis with unstable pelvic ring disruption, a right sacral fracture extending into the neural foramina, lumbar compression fractures, left tibial and fibular shaft fractures, a left medial malleolus fracture, and retroperitoneal hematoma. Following initial resuscitation and stabilization, the patient underwent open reduction and internal fixation (ORIF) of the anterior pelvic ring symphyseal locked fracture dislocation with symphyseal plate, and the sacral fracture was treated conservatively, in addition to intramedullary nailing of the left tibial shaft fracture and ORIF to the medial malleolus with screws. The lumbar spine fractures were managed conservatively. He was discharged after 11 days of programmed rehabilitation and physical therapy without any neurological deficits or unexpected events. This case highlights the importance of accurate imaging, meticulous preoperative planning, and multidisciplinary management in the treatment of locked pubic symphysis associated with complex polytrauma and the programmed rehabiliation. Early recognition, appropriate surgical intervention, and individualized conservative management of the posterior pelvic ring were associated with restoration of pelvic stability and a favorable clinical outcome in this case.