Orthopedic management of pubic symphysis osteomyelitis: a case series

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.

Peripartum Pubic Symphysis Diastasis—Practical Guidelines

Optimal development of a fetus is made possible due to a lot of adaptive changes in the woman’s body. Some of the most important modifications occur in the musculoskeletal system. At the time of childbirth, natural widening of the pubic symphysis and the sacroiliac joints occur. Those changes are often reversible after childbirth. Peripartum pubic symphysis separation is a relatively rare disease and there is no homogeneous approach to treatment. The paper presents the current standards of diagnosis and treatment of pubic diastasis based on orthopedic and gynecological indications.

A case–control study of clinical characteristics and risk factors of symptomatic postpartum pubic symphysis diastasis

Postpartum pubic symphysis diastasis (PPSD) refers to the separation of pubic symphysis after delivery. It is typically diagnosed based on clinical symptoms and radiologic findings. This study tried to assess clinical characteristics and risk factors of PPSD. This was a nested case–control study matched for year of delivery and gestational age at delivery using a retrospective cohort of women who delivered vaginally at a single institution. The incidence of PPSD was 0.156% (33/21,131). The incidence rate increased from 0.08% (7/9328) in 2000–2004 to 0.13% (9/7138) in 2005–2009 and to 0.36% (17/4665) in 2010–2016, simultaneously with an increase of maternal age (30.7 ± 3.5 years in 2000–2004 to 31.8 ± 3.8 years in 2005–2009 and 32.8 ± 3.8 years in 2010–2016). Nulliparity was associated with a higher incidence of PPSD (81.8% in cases vs. 57.6% in controls, p = 0.01). Other factors including pre-pregnancy body mass index, weight gain during pregnancy, gestational diabetes, induction of labor, duration of labor, epidural anesthesia, vacuum-assisted delivery, episiotomy, neonatal sex and birth weight failed to show difference between the two groups. In short, the incidence of PPSD increased with time along with an increase of maternal age. Nulliparity was the only significant risk factor for PPSD.

Comparative characteristics of pregnancy-related symphysis pubis dysfunction

The problem of an acceptable choice of the method of delivery for symphysis pubis dysfunction is relevant in modern obstetrics. Since the incidence of this condition varies between 1 in 300 and 1 in 30,000 pregnancies. And such a large variation in the frequency of symphysis pubis dysfunction is explained by the lack of a clear terminology for this disease, pathogenesis, and uniform diagnostic criteria. Purpose of the study. Analysis and comparative characteristics of pregnant women with pubis symphysis diastasis and clinical dysfunction of the pubis symphysis and without it. Material and methods. A retrospective analysis of 1210 birth histories and exchange cards of pregnant women in the period from 2015 to 2019. Results and discussion. In the group with clinical manifestations of pubic symphysis dysfunction, with overweight and obese of I, II, III degrees, as well as with diseases of the blood, cardiovascular system and endocrine disorders. And the group without clinical manifestations of pubic symphysis dysfunction consisted of multigravida with normal body weight. Conclusions. Vaginal delivery preferred by method of delivery for pregnant women with or without clinical manifestations of pubic symphysis, associated with minimal risk of pubis symphysis rupture. Keywords: pubis dysfunction, pregnancy, delivery.

Clinical case of pubic symphysis diastasis in a pregnant woman with atypical clinical features

This article presents a clinical case of pubic symphysis diastasis in a pregnant woman with atypical clinical features. From 24 weeks of gestation, the patient noticed an intermittent low back aching pain radiated to posterior surface of the right thigh. The pain was regarded as a manifestation of lumbar osteochondrosis, and the patient did not receive specific treatment. At 39-40 weeks of pregnancy, the woman complained of severe pain in the left iliac region that appeared while lying on the left side or turning in bed. The differential diagnosis included acute abdomen and pubic symphysis diastasis. During diagnostic research, clinical features of acute abdomen were not found. The diagnostic tests such as tenderness palpation of pubic symphysis, P4 test, Patricks test, modified Trendelenburgs test, and Mennells test were positive. According to ultrasound, the width of the pubic symphysis was 8.9 mm, with a 2 mm deviation of pubic ramus relative to the sagittal plane, ill-defined margin and inhomogeneous structure of the symphysis due to hypoechogenic inclusions with a total area of about 50%. Thus, the patient was diagnosed with pubic symphysis diastasis of the 2nd degree. Given the severe pain syndrome and a high risk of pubic symphysis fracture during labor, this case required surgical delivery. The postoperative period elapsed without complication.