Osteomyelitis of the pubic symphysis after urologic surgery

Osteomyelitis represents a pyogenic infection of the bone and marrow. The diagnosis is based on specific criteria and often is difficult to make. Herein we present 2 cases initially thought to represent osteitis pubis but subsequently proved to be osteomyelitis and compare the 2 entities with emphasis on differential diagnosis and treatment. Despite certain differentiating characteristics the correct diagnosis is often uncertain without histologic examination. Since the treatment of these 2 entities is quite different equivocal cases should undergo surgical exploration and bone curettage. This procedure will enable definite diagnosis to be made and proper treatment to be instituted.

Direct radiographic magnification for skeletal radiology. An assessment of image quality and clinical application

Recent advances in technology have made radiographic magnification of the skeleton clinically feasible. A new electron gun micro-focal tube combined with new high-resolution recording systems were used to perform magnification radiography which was then compared with conventional contact radiography. Quantitative evaluation included measurements of speed, contrast, resolution, and noise. Qualitative evaluation included an analysis of 215 clinical cases in which both techniques were used. The superior image quality of direct radiographic magnification is confirmed and the clinical areas in which it proved most helpful are defined.

Adductor avulsive injuries near the symphisis pubis

Avulsion injuries occurring near the symphisis pubis are related to the sites of origin of the adductor longus, adductor brevis, and gracilis muscles. Young athletes complain of pain near the symphisis which is increased by active adduction of the limb against resistance. Radiographic findings, similar to those found in infection and neoplasms, are mixed bone destruction and sclerosis on one side of the symphisis, frequently extending inferior pubic ramus.

Subchondral resorption of bone in renal osteodystrophy

In a radiographic-pathologic study of the spine and several axial joints in a cadaver with renal osteodystrophy, subchondral resorption of bone is described as an important mechanism of osseous abnormality. Widening and irregularity of the sacroilliac and sternoclavicular joints and symphysis pubis are related predominantly to trabecular destruction beneath cartilage surfaces, substitutive fibrosis, and new bone formation. Subperiosteal abnormalities at these locations produce juxta-articular erosions. The presence of osteitis fibrosa cystica about multiple Schmorl's nodes within the thoracic vertebral bodies suggests that subchondral resorption beneath the cartilage end-plates of the spine may be associated with disk protrusions and represents one further example of hyperparathyroid joint disease.

[Xeroradiography and its value in the diagnosis of chondrocalcinosis (author's transl)]

Conventional x-ray and xeroradiographic technique were compared in a modified blind study in order to evaluate its efficiency to detect calcifications of the cartilage. Using both techniques knees, hands, and pelvic joints were examined in 16 patients with proven chondrocalcinosis. Three different radiologists evaluated radiological films and xeroradiograms independently. Their results were classified in correct, false negative, and false positive groups. All examiners achieved the best results with xeroradiography. Due to special characteristic features in xeroradiography even fine calcifications were recognized in most cases. By this method the "false negative" results were reduced to almost zero. On the other hand, the twenty percent "false positive" results in conventional radiological technique was eliminated by xeroradiography.

[Surgical treatment of injuries of the anterior segment of the pelvic girdle]

The author described the results of surgical therapy for fractures of the anterior portion of the pelvic girdle and rupture of the pubic symphysis. The author has studied the surgical anatmy of these injuries, also original securing devices and some instruments were devised and operative approaches, employed in surgical procedures on pelvic bones, were elaborated. Indications and contraindications to surgery and the rationality of using some or other metallic constructions were studied. Observations over 27 of 76 patients operated upon for different pelvic fractures during the period of 1963-1974 are reported. The method allowed a close juxtaposition and fixation of fragments with the resulting good anatomical and functional issues without using external immobilization. The results of the treatment were mostly favourable.

Lesions of the symphysis pubis in women

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Lesions of the symphysis in athletes

In a radiological study of the pubic symphysis in 37 athletes (26 footballers and 11 others) and 156 young men as controls changes similar to those of osteitis pubis were found in 19 (76%) of the footballers and nine of the other athletes (81%) and 70 of the controls (45%). In the controls there was a significant correlation between their athletic ability and these changes.The clinical features consist of pain in the region of the pubis which may radiate to the groin or lower abdomen. Clicking may be present and indicates instability. Local tenderness is the only significant sign. Radiographs may show a combination of marginal irregularity, reactive sclerosis, and instability.A chronic stress lesion in the iliac component of a sacro-iliac joint was found in 20 out of 37 athletes, and 13 of them had instability at the pubic symphysis.It is concluded that repeated minor trauma is the primary aetiological factor. Though the radiological appearance may resemble that of osteitis pubis, there was no evidence that infection caused the lesion in this series. Spontaneous remission of symptoms is the most likely outcome. Rest from physical exertion is the most effective treatment, and stabilization of the pubic symphysis is indicated only rarely.