Orthopedic management of pubic symphysis osteomyelitis: a case series

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 [Formula: see text] test was utilized to compare the differences in outcome measures. An [Formula: see text] 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 [Formula: see text] standard deviation (SD) follow-up of 19 [Formula: see text] 12 months (range 6–37 months). Mean [Formula: see text] SD age was 76.2 [Formula: see text] 9.6 years (range 61.0–88.0 years) and body mass index (BMI) was 28.0 [Formula: see text] 2.9 kg/m [Formula: see text] (range 23.0–30.8 kg/m [Formula: see text]). When postoperative radiographs were compared to final follow-up radiographs, there were no significant differences in pubic symphysis diastasis ([Formula: see text] [Formula: see text] 0.221) or SI joint diastasis (right, [Formula: see text] [Formula: see text] 0.529 and left, [Formula: see text] [Formula: see text] 0.186). All patients were ambulatory without infection recurrence at final follow-up. Mean improvement for NPRS was 5.6 [Formula: see text] 3.4 ([Formula: see text] [Formula: see text] 0.020) and mean improvement for SF-36 physical functioning was 53.0 [Formula: see text] 36.8 ([Formula: see text] [Formula: see text] 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.