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Case Reports
. 2020 Oct 21:30:100357.
doi: 10.1016/j.tcr.2020.100357. eCollection 2020 Dec.

Adult female patient with osteitis pubis and pelvic instability requiring surgery: A case report

Khalil Nasrallah  1 , Mahmoud Jammal  2 , Amal Khoury  2 , Meir Liebergall  2
Affiliations
Case Reports

Adult female patient with osteitis pubis and pelvic instability requiring surgery: A case report

Khalil Nasrallah et al. Trauma Case Rep. .

Erratum in

Abstract

Background: Osteitis pubis (OP) is an inflammatory condition of the symphysis pubis (SP) characterized by focal pain and local tenderness. Pelvic instability (PI) is commonly associated with this condition. It is still not clear if OP leads to PI or it is PI that leads to OP. The exact cause of osteitis pubis is not yet known, although several predisposing factors have been suggested to contribute to this condition. In most cases, it is self-remitting and rarely needs surgical intervention.

Case presentation: A 63-year old woman presented with a 12-month history of persistent pain at the symphysis pubis and non-responsive to analgesics. The pain was aggravated by physical activity such as standing and walking. Physical examination showed focal tenderness at the symphysis pubis with no tenderness over the sacroiliac joints or lumbar region. The diagnosis was confirmed by characteristic findings on radiographs, CT and MRI. Surgery was considered after all conservative measures failed. The patient underwent a wedge-shaped resection of the symphysis pubis; the bone defect was filled autologous tri-cortical bone and fixed with dual plating. The outcome was satisfactory with radiologic union and symptom resolution postoperatively.

Conclusions: Osteitis pubis due to pelvic instability can cause chronic and persistent pain. In cases where conservative treatment fails, surgery should be considered. We recommend wide surgical resection of all non-viable bone at the symphysis pubis with the addition of tri-cortical iliac bone graft. Double plating should be considered in order to maximize the rate of fusion and further stabilize the fixation.

Keywords: Osteitis pubis; Pelvic instability; Symphysis pubis; Tri-cortical iliac bone graft; Wedge-shaped resection.

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Figures

Fig. 1
Fig. 1
Standing AP plain film of the pelvic illustrating characteristic radiologic signs of osteitis pubis: sclerosis, irregular margins of the cortex and cystic changes at the symphysis pubis. (Case I).
Fig. 2
Fig. 2
CT scan with axial slices showing characteristic signs of osteitis pubis: hypo-density of bone and irregular cortices at the symphysis pubis. (Case I).
Fig. 3
Fig. 3
Axial T2-section of MRI showing bilateral bone marrow edema, periarticular edema, symphyseal fluid and symphyseal gap. (Case I).
Fig. 4
Fig. 4
Intra-operative fluoroscopy showing the symphysis pubis after wide resection and the addition of a tri-cortical iliac bone graft that was fixated with two orthogonal plates as described in the text.
Fig. 4a
Fig. 4a
Immediate post-operative AP, Inlet and Outlet pelvic views showing symphyseal fusion with double plating after wide resection and the addition of tri-cortical bone graft.
Fig. 5
Fig. 5
Follow up X ray 1 year after the surgery showing healed OP with bone union over the arthrodesis site. (Case 1).
See this image and copyright information in PMC

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