Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients

Sacral insufficiency fractures are a frequent and painful consequence of pubic symphysis osteomyelitis

BACKGROUND

Pubic symphysis osteomyelitis can result from urosymphyseal fistula formation. High rates of sacropelvic insufficiency fractures have been reported in this population. The aim of this study was to describe the presentation and risk factors for sacral insufficiency fractures (SIF) associated with surgical treatment of pubic symphysis osteomyelitis.

METHODS

A retrospective review was performed for 54 patients who underwent surgery for pubic symphysis osteomyelitis associated with a urosymphyseal fistula at a single institution from 2009 to 2022. Average age was 71 years and 53 patients (98%) were male. All patients underwent debridement or partial resection of the pubic symphysis at the time of fistula treatment. Average width of the symphyseal defect was 65 mm (range 9-122) after treatment.

RESULTS

Twenty patients (37%) developed SIF at a mean time of 4 months from osteomyelitis diagnosis. Rate of sacral fracture on Kaplan-Meier analysis was 31% at 6 months, 39% at 12 months, and 41% at 2 years. Eleven patients developed SIF prior to pubic debridement and 12 patients developed new or worsening of pre-existing SIF following surgery. Width of pubic resection was higher in patients who developed SIF (76 mm vs. 62 mm), but this did not meet statistical significance (p = 0.18).

CONCLUSION

Sacral insufficiency fracture is a common sequela of pubic symphysis osteomyelitis. These fractures are often multifocal within the pelvis and can occur even prior to pubic resection. Pubectomy further predisposes these patients to fracture. Clinicians should maintain a high index of suspicion for these injuries in patients with symphyseal osteomyelitis.

Aerococcus urinae infection of the pubic symphysis: A rare case report

Aerococcus urinae is a Gram-positive, catalase-negative coccus, rarely responsible for urinary tract infections and seldom described for musculoskeletal infections like spondylodiscitis. An 86-year-old man presented to our hospital for groin pain without fever. Pelvic CT-guided biopsy revealed an A. urinae pubic symphysis osteomyelitis. He received a treatment by amoxicillin per os for six weeks, and did not need any surgery. An eight -month- follow-up showed a favorable evolution. Pubic symphysis infection can be induced by a wide variety of pathogens, and may have very different clinical presentations. Some authors recommend systematic surgery, but in case of susceptible pathogen associated with a low level of joint destruction, medical treatment alone should be sufficient to cure and make surgery unnecessary.

Septic Arthritis of the Pubic Symphysis in a 16-Year-Old Male Adolescent: A Case Report

CASE

A 16-year-old male adolescent presented with 4 weeks of right-sided hip pain and fever in the setting of recent groin trauma. He was diagnosed with septic arthritis of the pubic symphysis (SAPS) and was treated nonoperatively with antibiotics. Symptoms recurred, and he underwent surgical drainage of the pubic symphysis followed by a prolonged course of antibiotics. Follow-up at 12 months indicated complete symptom resolution.

CONCLUSION

This is the ninth reported adolescent case of SAPS. Although the presentation and disease course closely resembled those reported in the literature, this is the only case that required surgical intervention after failed nonoperative management.

Acute Osteomyelitis of the Pubic Symphysis: A Case Report

Pubis osteomyelitis is an uncommon disease, accounting for less than 1% of all bone infections. It occurs secondarily to hematogenous bacterial planting or direct inoculation. Clinically, it presents with intense acute pubic pain, limited mobility, and high fever, so it is rarely suspected initially. Its diagnosis can be easily confused with pubalgia, that do not respond to treatment. We present the case of a 17-year-old patient who sought consultation for three weeks of coxalgia associated with general discomfort and fever. Following a laboratory and imageological study, the diagnosis of acute pubis osteomyelitis was determined, which required surgical intervention and a subsequent pharmacological therapy for six weeks.

[Infected pseudarthrosis of the symphysis with persisting instability : Revision osteosynthesis with tantalum cage and silver ionized ITS plate after peri-implant infection with MRSE after osteosynthetic stabilization of a type C pelvic injury]

Overall symptomatic pseudathrosis after pelvic ring fracture is rare. A pseudarthrosis of the dorsal pelvic ring often leads to persisting pain due to instability and needs a consequent treatment strategy. Often a bacterial infection can be found in persisting pseudarthrosis notably in the anterior pelvic ring region. It is assumed that the peculiar anatomical site of the surgical approach - pubic region and abdominal skinfold - in particular accompanied with adipositas is predestined. Often patients with pseudathrosis and proof of bacterial infection show no symptoms. In these cases treatment is not mandatory. Patients however who complain about persisting pain limited treatment options exist.The following case report demonstrates a treatment strategy to achieve pelvic ring stability and infection eradication using a silver ionised plate and screws as well as a tantalum cage.