Encountering pelvic tuberculosis in closed pelvic ring injury with distant wound - An intraoperative surprise: A case report

Abstract

Delayed presentation of closed APC type III pelvic ring injury with a healing wound on the medial thigh, in a twenty-six-year-old male, at four weeks. We planned Symphyseal plating and sacroiliac screw fixation surgery. After percutaneous screw fixation, subsequent pelvic exposure revealed whitish cheesy pus in the retropubic space. Hence, we changed surgery from internal fixation to a supra-acetabular external fixator. Subsequent molecular testing documented tuberculosis and regimen of antitubercular medications was started. Complete functional recovery was observed at 12 months. While managing pelvic injuries, alternative backup treatment plans should be kept ready in view of infective foci.

Keywords: APC III pelvic ring injury; Morell-Lavalle lesion; Pelvis external fixator; Sacro-iliac screw fixation; Tuberculosis.

Fig. 1

a) Anterior-posterior radiograph of the pelvis, showing pubic symphysis and right sacroiliac joint disruption b) 3D reconstruction of the preoperative computed tomography scan of the pelvis showing complete right sacroiliac joint disruption.

Fig. 2

a) Intraoperative image showing the presence of milky white discharge in the retropubic space b) Histopathological picture showing fibrocartilaginous tissue with bony trabeculae mixed with multiple epithelioid cell granulomas with areas of caseous necrosis and multiple Langhans giant cells.

Fig. 3

1-month postoperative anterior posterior radiograph of the pelvis showing placement of the pelvic external fixator and right sacroiliac screw b) 1-year postoperative anterior posterior radiograph of the pelvis showing well healed pubic symphysis after removal of external fixator and healed sacroiliac disruption.

Fig. 4

Clinical images of the patient showing well healed surgical scars and achievement of full Range of Motion of the hip, at latest follow up, 1 year.