Abstract. Objectives: The purpose of this case series is to describe the orthopedic
management of pubic symphysis osteomyelitis with an emphasis on the key
principles of treating bony infection. Furthermore, we sought to identify whether debridement of the pubic symphysis without subsequent internal fixation
would result in pelvic instability.
Methods: A retrospective chart review was performed to identify all cases of
pubic symphysis osteomyelitis treated at both institutions from 2011 to 2020. Objective outcomes collected included infection recurrence, change in pubic
symphysis diastasis, sacroiliac (SI) joint diastasis, and ambulatory status.
Subjective outcome measures collected included the numeric pain rating scale
(NPRS) and the 36-Item Short Form Survey (SF-36). Pubic symphysis diastasis
was measured as the distance between the two superior tips of the pubis on a
standard anterior–posterior (AP) view of the pelvis. SI joint diastasis was measured bilaterally as the joint space between the ileum and sacrum
approximately at the level of the sacral promontory on the inlet view of the
pelvis. A paired t test was utilized to compare the differences in outcome measures. An α value of 0.05 was utilized. Results: Six patients were identified, of which five were males and one was
female (16.7 %), with a mean ± standard deviation (SD) follow-up of 19 ± 12 months (range 6–37 months). Mean ± SD age was 76.2 ± 9.6 years (range 61.0–88.0 years) and body mass index (BMI) was 28.0 ± 2.9 kg/m2 (range 23.0–30.8 kg/m2). When postoperative
radiographs were compared to final follow-up radiographs, there were no
significant differences in pubic symphysis diastasis (P = 0.221) or SI
joint diastasis (right, P = 0.529 and left, P = 0.186). All patients were ambulatory without infection recurrence at final follow-up. Mean improvement
for NPRS was 5.6 ± 3.4 (P = 0.020) and mean improvement for SF-36
physical functioning was 53.0 ± 36.8 (P = 0.032).
Conclusion: This case series highlights our treatment strategy for pubic
symphysis osteomyelitis of aggressive local debridement with local
antibiotic therapy. Additionally, debridement of the pubic symphysis without
subsequent internal fixation did not result in pelvic instability, as
determined by pelvic radiographs and ability to fully weight bear postoperatively.
Bladder incarceration following anterior pelvic infix of a traumatic pubic symphysis diastasis treated with immediate open reduction and internal fixation
