Orthopedic management of pubic symphysis osteomyelitis: a case series.

Henry T Shu,Ahmed H Elhessy,Arthur L Burnett,Babar Shafiq,Janet D Conway

doi:10.5194/jbji-6-273-2021

Henry T Shu, Ahmed H Elhessy + Show 3 more

Open Access

https://doi.org/10.5194/jbji-6-273-2021

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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 test was utilized to compare the differences in outcome measures. An 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/m (range 23.0–30.8 kg/m). When postoperative radiographs were compared to final follow-up radiographs, there were no significant differences in pubic symphysis diastasis ( 0.221) or SI joint diastasis (right, 0.529 and left, 0.186). All patients were ambulatory without infection recurrence at final follow-up. Mean improvement for NPRS was 5.6 3.4 ( 0.020) and mean improvement for SF-36 physical functioning was 53.0 36.8 ( 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.

Highlights

Pubic symphysis osteomyelitis is a rare complication following urological surgery (Kahokehr et al, 2020; Lavien et al, 2017; Nosé et al, 2020)
The one female identified in this study was diagnosed with idiopathic pubic symphysis osteomyelitis, which was confirmed by a computed tomography (CT)-guided biopsy of the pubic symphysis
All males had a history of recurrent urinary tract infections (UTIs) prior to the development of pubic symphysis osteomyelitis

Summary

Introduction

Pubic symphysis osteomyelitis is a rare complication following urological surgery (Kahokehr et al, 2020; Lavien et al, 2017; Nosé et al, 2020). Bony infection of the pubic symphysis following urological surgery typically presents with pain in the groin or paramidline over the pubis with tenderness with or without purulent drainage from previous incisions (Burns and Gregory, 1977; Del Busto et al, 1982; Gupta et al, 2015). In acute cases of osteomyelitis, there may be elevated C-reactive protein (CRP), leukocytosis, and elevated erythrocyte sedimentation rate (ESR) (Del Busto et al, 1982; Gupta et al, 2015). Shu et al.: Orthopedic management of pubic symphysis osteomyelitis

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