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Jiang D, Wang X, Dlixiat A, Ma L, Xu Z, Sun G, Jia R, Wu Y, Zhang Y. Comparison of two surgical interventions for advanced stages pubis and pubic symphysis tuberculosis in adults: A retrospective study of 33 cases. Injury 2023; 54:111155. [PMID: 37919114 DOI: 10.1016/j.injury.2023.111155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To compare the clinical efficacy of two surgical interventions in treating advanced stages TB of the pubis and pubic symphysis. METHODS Between June 2010 and January 2020, 33 cases of the advanced pubis and pubic symphysis TB were treated with a one-stage debridement procedure (debridement only group, n = 15) or a one-stage debridement with bone grafting and plate fixation procedure (debridement + plating group, n = 18). The visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), operation time, intraoperative blood loss, complications, time of bone graft fusion, and improvement in the mental component summary (MCS) and physical component summary (PCS) of Short Form-36 (SF-36) were compared and analyzed. RESULTS All patients were followed for 24.9 (SD 1.6) months. All patients were completely cured of the pubis and pubic symphysis TB with no recurrence. There were no significant differences (P >0.05) between the two groups in terms of age, follow-up period and intraoperative blood loss. The post-operative VAS scores, ESR and CRP levels, PCS and MCS scores of two groups significantly improved compared to pre-therapy. The mean operation time in debridement + plating group was 140.9 (43.2) min, which was significantly longer than in debridement only group [94.9(21.8) min, P < 0.01]. The final follow-up (FFU) indices of the VAS score in debridement only group were higher than those in debridement + plating group [1.9 (0.8) vs 1.3 (0.5), P=0.012]. A satisfactory average bony fusion time of 12.2 (3.3) months was achieved in debridement + plating group . CONCLUSIONS A one-stage debridement, bone grafting, and reconstruction plate fixation procedure achieved reconstruction of the integrity and stability of the pelvic ring, pain relief, and rapid cure of bone TB. This procedure is a safe and effective treatment option for advanced pubis and pubic symphysis TB.
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Affiliation(s)
- Dingyu Jiang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Xiyang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China.
| | - Abulizi Dlixiat
- Department of Orthopedics, The Eighth Affiliated Hospital of Xinjiang Medical University, No.106 Yan 'an Road, Tianshan District, Urumqi city, Xinjiang Uygur Autonomous Region 830049, China
| | - Liang Ma
- Department of Orthopedics, The Eighth Affiliated Hospital of Xinjiang Medical University, No.106 Yan 'an Road, Tianshan District, Urumqi city, Xinjiang Uygur Autonomous Region 830049, China
| | - Zhenchao Xu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Guannan Sun
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Runze Jia
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Yunqi Wu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Yilu Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
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2
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Kim N, Hance F, Barsi J. Septic Arthritis of the Pubic Symphysis in a 16-Year-Old Male Adolescent: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00038. [PMID: 38048409 DOI: 10.2106/jbjs.cc.23.00475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
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.
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Affiliation(s)
- Noah Kim
- Department of Pediatric Orthopedic Surgery, Stony Brook University Hospital, Stony Brook, New York
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3
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Suarez RI, Polmann M, Del Pilar Bonilla L, Torres-Viera CG, Bedran K. Immunosuppression and Opportunistic Infections: A Rare Case Report of Nocardia Osteomyelitis of the Pelvis. Cureus 2023; 15:e45306. [PMID: 37846230 PMCID: PMC10576979 DOI: 10.7759/cureus.45306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023] Open
Abstract
Patients with a long-standing history of immunosuppression are at significantly increased risk of opportunistic infections. One such group of organisms that may cause these types of infections includes the Nocardia genus, a gram-positive, filamentous rod that demonstrates a branching pattern, is urease-producing and has acid-fast properties. The disease profile of Nocardia varies with manifestations ranging from cutaneous infection to severe pulmonary or central nervous system (CNS) infections, and rarely, osteomyelitis. In this case report, we present an 87-year-old female with persistent left gluteal and lumbar pain, generalized body aches, chills, and fevers diagnosed with Nocardia asiatica osteomyelitis of the pelvis, likely secondary to dissemination from pulmonary cavitary disease in an immunosuppressed host with chronic neutropenia. On magnetic resonance imaging (MRI), the patient was found to have heterogeneous enhancement, central necrosis, and loss of cortical margins of the left iliac wing, alongside a rim-enhancing soft tissue mass from the left iliac bone into the left gluteal soft tissues and left paraspinal musculature representing an abscess. She was promptly treated with surgical irrigation and drainage with surgical wound cultures growing Nocardia asiatica. She received treatment with trimethoprim-sulfamethoxazole antibiotics with symptom improvement and is following up with an infectious disease physician outpatient. Management of osteomyelitis, like in this case, involves long-term antibiotics with the potential need for surgical intervention. There are few reported cases of extrapulmonary Nocardia infections, particularly osteomyelitis, demonstrating the importance of their inclusion in the literature to better serve patients to allow for timely intervention for rare and life-threatening conditions. In immunocompromised hosts, the differential diagnosis should include opportunistic infections and less common pathogens, especially in those with atypical presentations, including gluteal and leg pain.
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Affiliation(s)
- Richard I Suarez
- Health Policy, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Michaela Polmann
- Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | | | | | - Kebir Bedran
- Hospital Medicine, Baptist Health South Florida, Miami, USA
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Jara JA, Inostroza FA, Farias FI. Acute Osteomyelitis of the Pubic Symphysis: A Case Report. Cureus 2023; 15:e40329. [PMID: 37448424 PMCID: PMC10338084 DOI: 10.7759/cureus.40329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
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.
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Affiliation(s)
- Javier A Jara
- Orthopaedics and Trauma, Universidad de La Frontera, Temuco, CHL
- Orthopaedics and Trauma, Hospital Dr. Hernán Henríquez Aravena, Temuco, CHL
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5
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Kratzer F, Beck M, Hauck S, Militz M, Woltmann A. [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]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:498-503. [PMID: 35796816 DOI: 10.1007/s00113-022-01194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- Florian Kratzer
- Unfallchirurgie, Orthopädie und Allgemeinchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau am Staffelsee, Deutschland.
| | - Markus Beck
- Unfallchirurgie, Orthopädie und Allgemeinchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau am Staffelsee, Deutschland
| | - Stefan Hauck
- Unfallchirurgie, Orthopädie und Allgemeinchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau am Staffelsee, Deutschland
| | - Matthias Militz
- Unfallchirurgie, Orthopädie und Allgemeinchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau am Staffelsee, Deutschland
| | - Alexander Woltmann
- Unfallchirurgie, Orthopädie und Allgemeinchirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau am Staffelsee, Deutschland
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Yanagita Y, Shimada R, Noda K, Ikusaka M. Pubic Osteomyelitis in a Young Athlete. Cureus 2023; 15:e35329. [PMID: 36968939 PMCID: PMC10038743 DOI: 10.7759/cureus.35329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
We describe a case of pubic osteomyelitis in a 17-year-old Japanese male. The patient presented with acute left groin pain and left lower quadrant pain. He was evaluated at another hospital where pelvic X-ray/computed tomography was normal, and laboratory testing revealed only high C-reactive protein. Pelvic magnetic resonance imaging (MRI) on day three showed inflammation of the pubic attachment of the rectus abdominis muscle. Furthermore, a pelvic MRI performed 10 days after onset revealed a high signal on T2 short-TI inversion recovery in the left pubic bone, which was not found in the previous MRI, leading to a diagnosis of left pubic osteomyelitis. Symptoms improved rapidly after antibiotic therapy, and treatment was completed after six weeks. When a young athlete presents with fever and acute inguinal pain, osteomyelitis of the pubic bone should be considered as a differential diagnosis. This case report emphasizes the importance of taking a sports history during the interview and performing a repeat MRI for the early diagnosis of osteomyelitis of the pubic bone.
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7
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Sinha S, Qureshi OA, Kumar A, Thakral AK, Mohsin M, Kumar S. Pubic Symphysis Osteomyelitis after Bilateral Laproscopic Hernia Repair: A Case Report and Review of Literature. J Orthop Case Rep 2022; 12:44-49. [PMID: 36874894 PMCID: PMC9983379 DOI: 10.13107/jocr.2022.v12.i10.3360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/17/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Pubic symphysis osteomyelitis is a rare complication of hernia repair, it is easily mistaken for osteitis pubis (OP) which can lead to a significant delay in diagnosis and prolonged pain for the patient. Case Report We present the case of a 41-year-old male who presented with complaints of diffuse low back pain, perineal pain for 8 weeks after bilateral laparoscopic hernia repair. The patient was initially considered to have OP and managed however pain did not relieve with treatment. There was tenderness in the ischial tuberosity only. At the time of presentation, X-ray revealed areas of erosion and sclerosis in the pubis with increased inflammatory markers. Magnetic resonance imaging showed an altered marrow signal in the pubic symphysis, edema in the gluteus maximus on the right side, and collection in the peri-vesical space. The patient was started on oral antibiotics for 6 weeks and clinicoradiological improvement was noted. Conclusion Pubic osteomyelitis and OP show similar clinical presentations with contrasting treatments. Early identification and initiation of appropriate treatment can decrease morbidity and improve outcomes.
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Affiliation(s)
- Siddhartha Sinha
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Owais A Qureshi
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Arvind Kumar
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
| | - Ajay K Thakral
- Department of Surgery, Hamdard Institute of Medical Sciences and Research, Guru Ravidas Marg, New Delhi, India
| | - Mohammed Mohsin
- Department of Surgery, Hamdard Institute of Medical Sciences and Research, Guru Ravidas Marg, New Delhi, India
| | - Sandeep Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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8
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Amer ML, Omar K, Malde S, Nair R, Thurairaja R, Khan MS. The challenges in diagnosis and management of osteitis pubis: An algorithm based on current evidence. BJUI COMPASS 2022; 3:267-276. [PMID: 35783593 PMCID: PMC9231671 DOI: 10.1002/bco2.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 02/01/2023] Open
Abstract
Objective The objective of this study is to summarise the contemporary evidence regarding the prevalence, diagnosis, and management of osteitis pubis (OP) specially from urological point of view, while proposing an algorithm for the best management based on the current evidence. Methods We performed a literature search using the PubMed database for the term ‘osteitis pubis’ until December 2020. We assessed pre‐clinical and clinical studies regarding the aetiology, pathophysiology, and management of OP. Case reports and case series were evaluated by study quality and patient outcomes to determine a potential clinical management algorithm. Results Osteitis pubis is a chronic painful condition of the symphysis pubis joint and its surrounding structures. Still, there is a paucity of data outlining the management plan and the possible triggers. The aetiology seems to be multifactorial with different proposals trying to explain the pathophysiology and correlate the findings to the outcome. The diagnosis is usually based on high suspicion index and clinical experience. The infective variant of the disease is aggressive and requires strict and active management. Universal consensus is still lacking regarding a formal algorithm of management of the condition, especially due to multiple specialities involved in the decision‐making process. Conservative management remains the cornerstone; nevertheless, surgical interventions may be needed in special settings. Hence, a multi‐disciplinary approach is of pivotal value in fashioning the plan for each case. The prognosis is usually satisfactory; however, a longstanding debilitating disease form is not uncommon. Conclusion OP remains a rare condition with real challenges in its diagnosis. The current management is focused on conservative management; however, surgical intervention is still needed in some difficult scenarios. Continued research into the triggers of OP, multidisciplinary approach, and standardised clinical pathways can improve the quality of care for patients suffering from this condition.
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Affiliation(s)
- Mohammed Lotfi Amer
- Faculty of Medicine Tanta University Tanta Egypt
- Department of Urology Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Kawa Omar
- Department of Urology Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Sachin Malde
- Department of Urology Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Rajesh Nair
- Department of Urology Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Ramesh Thurairaja
- Department of Urology Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Muhammad Shamim Khan
- Department of Urology Guy's and St. Thomas' NHS Foundation Trust London UK
- MRC Centre for Transplantation, Faculty for Life Sciences and Medicine, NIHR Biomedical Research Centre King's College London London UK
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9
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Best K, Hussien S, Malik A, Patel S, Michael MB. Suprapubic Osteomyelitis in an Intravenous Drug User: A Case Report. Cureus 2022; 14:e21312. [PMID: 35186571 PMCID: PMC8848260 DOI: 10.7759/cureus.21312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/10/2022] Open
Abstract
We discuss a case of methicillin-resistant Staphylococcusaureus (MRSA) osteomyelitis pubis in a 45-year-old female patient with an active history of intravenous (IV) drug injection. While IV drug users are typically infected with Pseudomonas aeruginosa in cases of osteomyelitis of the pubic symphysis, our patient presented with a rare case of MRSA infection of the pubis symphysis. In this case, an investigation using magnetic resonance imaging (MRI), elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and culture was consistent with the diagnosis of osteomyelitis. Osteomyelitis pubis is an infection that causes necrosis and destruction of the pubic bone. This condition remains a rarity, as less than 1% of osteomyelitis cases are reported to involve the pubic symphysis, thus contributing to the delays observed between onset of symptoms and diagnosis. The goal of this case report is to promote awareness of this phenomenon to hasten diagnosis and early treatment. The recommended treatment is with IV antibiotics for MRSA coverage for four to six weeks’ duration; however, our patient left against medical advice.
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10
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Jha AK, Jalan D, Beniwal RK. Tubercular Osteomyelitis of Pubis with Labial Abscess: A Rare Presentation of a Common Disease. J Orthop Case Rep 2021; 11:22-25. [PMID: 35415143 PMCID: PMC8930370 DOI: 10.13107/jocr.2021.v11.i12.2550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Skeletal tuberculosis (TB) accounts for 10-15% of all cases of extra-pulmonary TB. The involvement of pubis is extremely rare with only 40 cases of pubic bone TB reported in the medical literature. The presentation of the disease with labial abscess is much rarer with only one case reported till now. Case Report A 23-year-old female presented with symptoms of pain and swelling in the right groin. The patient was evaluated with hematological and radiological investigations and the diagnosis of Tubercular osteomyelitis of pubis with labial abscess was confirmed using AFB staining and culture of the aspirate. The patient was subsequently managed with Anti-tubercular chemotherapy for 18 months and the lesion healed with excellent functional outcome. Conclusion Tubercular Osteomyelitis of the pubis is a rare disease with varied clinical presentation. Timely diagnosis and anti-tubercular chemotherapy usually result in complete recovery.
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Affiliation(s)
- Amit Kumar Jha
- Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Divesh Jalan
- Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India,Address of Correspondence: Dr. Divesh Jalan, Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029. India. E-mail:
| | - R K Beniwal
- Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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11
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Daniels SP, Viers CD, Blaichman JI, Ross AB, Tang JY, Lee KS. US-guided Musculoskeletal Interventions of the Body Wall and Core with MRI and US Correlation. Radiographics 2021; 41:2011-2028. [PMID: 34623945 DOI: 10.1148/rg.2021210050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chest, abdominal, and groin pain are common patient complaints that can be due to a variety of causes. Once potentially life-threatening visceral causes of pain are excluded, the evaluation should include musculoskeletal sources of pain from the body wall and core muscles. Percutaneous musculoskeletal procedures play a key role in evaluating and managing pain, although most radiologists may be unfamiliar with applications for the body wall and core muscles. US is ideally suited to guide these less commonly performed procedures owing to its low cost, portability, lack of ionizing radiation, and real-time visualization of superficial soft-tissue anatomy. US provides the operator with added confidence that the needle will be placed at the intended location and will not penetrate visceral or vascular structures. The authors review both common and uncommon US-guided procedures targeting various portions of the chest wall, abdominal wall, and core muscles with the hope of familiarizing radiologists with these techniques. Procedures include anesthetic and corticosteroid injection as well as platelet-rich plasma injection to promote tendon healing. Specific anatomic structures discussed include the sternoclavicular joint, costochondral joint, interchondral joint, intercostal nerve, scapulothoracic bursa, anterior abdominal cutaneous nerve, ilioinguinal nerve, iliohypogastric nerve, genitofemoral nerve, pubic symphysis, common aponeurotic plate, and adductor tendon origin. Relevant US anatomy is depicted with MRI correlation, and steps to performing successful safe US-guided injections are discussed. Confidence in performing these procedures will allow radiologists to continue to play an important role in diagnosis and management of many musculoskeletal pathologic conditions. ©RSNA, 2021.
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Affiliation(s)
- Steven P Daniels
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.)
| | - Charles D Viers
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.)
| | - Jason I Blaichman
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.)
| | - Andrew B Ross
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.)
| | - Joseph Y Tang
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.)
| | - Kenneth S Lee
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.)
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12
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Aggarwal A, Jain A. A case of suprapubic pain. Eur J Intern Med 2021; 88:116-117. [PMID: 33893019 DOI: 10.1016/j.ejim.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Anubhav Jain
- Ascension Genesys Hospital, Rochester, Michigan, USA
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13
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Glasser JG. Case report: Osteitis/osteomyelitis pubis simulating acute appendicitis. Int J Surg Case Rep 2018; 53:269-272. [PMID: 30447548 PMCID: PMC6240723 DOI: 10.1016/j.ijscr.2018.10.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022] Open
Abstract
There is a continuum between Athletic (Sports) Hernia, Osteitis Pubis, and Osteomyelitis Pubis. The pubis is the site of attachment of many “core” muscles. A lay term used to describe a hernia is “rupture”. Athletic hernia denotes a tear. Chronic musculotendinous strain may cause inflammation (osteitis pubis). An inflammatory focus may become a nidus for infection (osteomyelitis pubis). The symptoms caused by these three entities blur one with the other and with those characterizing acute appendicitis. This is an important association for clinicians to know.
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Affiliation(s)
- James G Glasser
- Janet Weis Children's Hospital, Geisinger Medical Center, 100N. Academy Ave., Danville, PA 17822, United States.
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Degheili JA, Mansour MM, Nasr RW. Symphysis Pubis Osteomyelitis: An Uncommon Complication after Robotic Assisted Radical Prostatectomy-Case Description with Literature Review. Case Rep Urol 2018; 2018:5648970. [PMID: 29666747 PMCID: PMC5831911 DOI: 10.1155/2018/5648970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/18/2018] [Indexed: 11/18/2022] Open
Abstract
Prostate cancer is the most common solid cancer among American men. Although there are various modalities for treatment, including radical prostatectomy among many others, the former is, nevertheless, not without any accompanied complications. Other than the well-known surgical complications such as erectile dysfunction, urinary incontinence, and voiding dysfunction, osteomyelitis of the symphysis pubis is not a well-understood complication, with various hypotheses explaining its pathogenesis. Although osteomyelitis of the pubis symphysis has been reported after endoscopic urological procedures such as transurethral resection of the prostate, it has rarely been reported after robotic surgeries. We hereby report, to the best of our knowledge, the first osteomyelitis of the pubis symphysis, after robotic prostatectomy, in a patient with prostate cancer and no previous radiation therapy.
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Affiliation(s)
- Jad A. Degheili
- Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Mazen M. Mansour
- Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Rami W. Nasr
- Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Riad El-Solh, Beirut 1107 2020, Lebanon
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15
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Chronic Pubis Osteomyelitis After Reconstructive Surgery for Bladder Prolapse. JOURNAL OF ORTHOPEDIC AND SPINE TRAUMA 2016. [DOI: 10.5812/jost.9601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Clinical and Radiological Recovery of Osteitis Pubis: Spontaneous or Steroid-Induced? Arch Rheumatol 2016; 32:84-85. [PMID: 30375540 DOI: 10.5606/archrheumatol.2017.5947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/03/2016] [Indexed: 11/21/2022] Open
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17
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Aouad P, Serhal A, Bleibel L, Haidar M, Mohanna A. Brucella osteomyelitis of the pubic bones. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Pieroh P, Spindler N, Langer S, Josten C, Böhme J. A double-barrelled fibula graft restoring pelvic stability after late posterior ring instability related to a surgical treated osteitis pubis: a case report. Arch Orthop Trauma Surg 2016; 136:47-53. [PMID: 26506827 DOI: 10.1007/s00402-015-2355-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Osteitis pubis or symphysitis pubis is a rare occurring non-infectious inflammation of the symphysis, the adjacent pubic bones and surrounding tissue. The therapy might be conservative or surgical by a resection of the symphysis and involved parts of the pubic bone. Nevertheless, this resection might lead to an anterior instability impairing the posterior arch and the sacroiliac joints in the aftermath. CASE PRESENTATION Here, we report about a 50-year-old women suffering from osteitis pubis treated by wedge resection of the symphysis and parts of the pubic bone. To maintain stability and for local antibiotic treatment a cement spacer was implemented. By clinical inconspicuous findings and the patient's desire, no further surgery was performed. However, 2 years after surgery the spacer dislocated and the patient complained about pain in the posterior arch due to an impaired mobility. Reconstruction surgery was planned including the bridging of the accrued space with a vascularized double-barrelled fibula graft, plate osteosynthesis and rectus abdominis flap coverage. The performed surgery led to pain relief and increased mobility. CONCLUSION The present case highlights the possible complication of surgical treated osteitis pubis leading to anterior arch instability affecting the posterior arch and thus impairing pelvic ring stability and patient mobility. Furthermore, we describe an opportunity to treat this complication or other etiologies contributing to anterior pelvic ring stability with large bone defects using a vascularized double-barrelled fibula graft to restore pelvic stability.
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Affiliation(s)
- Philipp Pieroh
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
- Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06097, Halle (Saale), Germany.
| | - Nick Spindler
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Stefan Langer
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Christoph Josten
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Jörg Böhme
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
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Angoules AG. Osteitis pubis in elite athletes: Diagnostic and therapeutic approach. World J Orthop 2015; 6:672-679. [PMID: 26495244 PMCID: PMC4610909 DOI: 10.5312/wjo.v6.i9.672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/13/2015] [Accepted: 08/07/2015] [Indexed: 02/06/2023] Open
Abstract
Osteitis pubis (OP) is a debilitating overuse syndrome characterizing by pelvic pain and local tenderness over the pubic symphysis commonly encountered in athletes often involved in kicking, twisting and cutting activities in sports such as soccer and rugby and to a lesser degree distance running. It is a common source of groin pain in elite athletes attributable to pubis sympysis instability as the result of microtrauma caused by repetitive muscle strains on pubic bones. Diagnosis is based mainly on detailed sports history and a meticulous clinical examination, although occasionally is difficult to distinguish this nosological entity from other pathologies affecting the involved area which may occur concomitantly in the same patient. Radiologic examinations such as plain radiographs, magnetic resonance imaging and 3 phase bone isotope scanning may be helpful to differentiate from other clinical entities with similar clinical presentation. Most cases respond well to conservative treatment which includes several physical modalities and especially a progressive rehabilitation programmed individualized to each one of patients diagnosed with OP. Local injection therapies have been also been proposed as a non-operative therapeutic option for the efficient management of these patients. In refractory cases, surgical therapeutic strategies are warranted. These include several open or minimally invasive surgical interventions such as arthroscopic or open symphysis curettage, wedge or total resection of pubic sympysis, polypropylene mesh placement and pubic fusion. In this review a critical analysis of OP in elite athletes is performed with special focus on current concepts of diagnosis and management of this source of athletic groin pain.
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Plateau B, Ruivard M, Montoriol PF. Prostatosymphyseal fistula and osteomyelitis pubis following transurethral resection of the prostate: CT and MRI findings. J Med Imaging Radiat Oncol 2015; 59:713-5. [PMID: 25908296 DOI: 10.1111/1754-9485.12304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/19/2015] [Indexed: 11/30/2022]
Abstract
We present a very rare case of osteomyelitis pubis in a 75-year-old male patient due to a prostatosymphyseal fistula, which constituted a few weeks after trans-urethral resection of the prostate. The patient had a previous history of prostatic carcinoma treated by radiotherapy, which may have played a role in the development of the fistula. Computed tomography with excretory phase and magnetic resonance imaging were performed and enabled to make the final diagnosis.
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Affiliation(s)
| | - Marc Ruivard
- Department of Internal Medicine, CHU Estaing, Clermont-Ferrand, France
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21
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Symphysis pubis osteomyelitis with bilateral adductor muscles abscess. Case Rep Orthop 2015; 2014:982171. [PMID: 25580335 PMCID: PMC4279146 DOI: 10.1155/2014/982171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/29/2014] [Indexed: 12/02/2022] Open
Abstract
Osteomyelitis of the pubis symphysis is a rare condition. There have been various reports in the literature of inflammation and osteomyelitis as well as septic arthritis of pubic symphysis. However, due to the fact that these conditions are rare and that the usual presenting symptoms are very nonspecific, osteomyelitis of the pubic symphysis is often misdiagnosed, thus delaying definitive treatment. We present a case that to our knowledge is the first case in literature of osteomyelitis of the pubic symphysis in a 17-year-old boy with juvenile idiopathic arthritis (JIA), which was initially misdiagnosed and progressed to bilateral adductor abscesses. A high suspicion of such condition should be considered in a JIA patient who presents with symphysis or thigh pain.
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El Mezouar I, Abourazzak FZ, Mansouri S, Harzy T. Septic arthritis of the pubic symphysis: a case report. Pan Afr Med J 2014; 18:149. [PMID: 25419287 PMCID: PMC4236770 DOI: 10.11604/pamj.2014.18.149.4421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 06/11/2014] [Indexed: 11/11/2022] Open
Abstract
Septic arthritis of the pubic symphysis, so called osteomyelitis pubis is the infection which involves pubic symphysis and its joint. It is a rare condition, representing less than one percent of all cases of osteomyelitis. It affects most frequently young athletes and women undergoing gynecologic or urologic surgery. It presents itself with fever and pubic pain which irradiates to the genitals and increases when hip is mobilized, and this fact produces gait claudication. Diagnosis is based on clinic supported by microbiologic culture results, image methods, and proteins augment during acute phase. The etiologic agents most commonly found are Staphylococcus aureus, followed by gram-negative bacilli, and polymicrobial infection in recent pelvis surgery. The antibiotic treatment is adjusted depending on the microbiological diagnosis, adding NSAIDs, and bed rest. We report a 16 year-old male presenting with pubic pain and fever. Magnetic resonance imagery showed arthritis of the pubic symphysis. The patient was treated with antibiotics with a good clinical response.
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Affiliation(s)
- Imane El Mezouar
- Rheumatology Department, Medical School, Sidi Mohammed Ibn Abdellah University, Hassan II University Hospital, Fez, Morocco
| | - Fatema Zahra Abourazzak
- Rheumatology Department, Medical School, Sidi Mohammed Ibn Abdellah University, Hassan II University Hospital, Fez, Morocco
| | - Samia Mansouri
- Rheumatology Department, Medical School, Sidi Mohammed Ibn Abdellah University, Hassan II University Hospital, Fez, Morocco
| | - Taoufik Harzy
- Rheumatology Department, Medical School, Sidi Mohammed Ibn Abdellah University, Hassan II University Hospital, Fez, Morocco
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Yax J, Cheng D. Osteomyelitis pubis: a rare and elusive diagnosis. West J Emerg Med 2014; 15:880-2. [PMID: 25493141 PMCID: PMC4251242 DOI: 10.5811/westjem.2014.8.13401] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 11/11/2022] Open
Abstract
Osteomyelitis pubis is an infectious inflammation of the symphysis pubis and accounts for 2% of hematogenous osteomyelitis. This differs from osteitis pubis, a non-infectious inflammation of the pubic symphysis, generally caused by shear forces in young athletes. Both conditions present with similar symptoms and are usually differentiated on the basis of biopsy and/or culture. A case of osteomyelitis pubis is presented with a discussion of symphisis pubis anatomy, clinical and laboratory presentation, etiology and risk factors, and optimal imaging studies.
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Affiliation(s)
- Justin Yax
- Case Western Reserve University, University Hospitals/Case Medical Center, Department of Emergency Medicine, Cleveland, Ohio
| | - David Cheng
- Case Western Reserve University, University Hospitals/Case Medical Center, Department of Emergency Medicine, Cleveland, Ohio
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24
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Retorno ao esporte após tratamento cirúrgico de pubeíte em jogadores de futebol profissional. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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de Queiroz RD, de Carvalho RT, de Queiroz Szeles PR, Janovsky C, Cohen M. Return to sport after surgical treatment for pubalgia among professional soccer players. Rev Bras Ortop 2014; 49:233-9. [PMID: 26229806 PMCID: PMC4511648 DOI: 10.1016/j.rboe.2014.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 10/08/2013] [Indexed: 12/04/2022] Open
Abstract
Objective to evaluate the return to sport after surgical treatment for pubalgia among 30 professional soccer players and describe the surgical technique used. Method this case series was evaluated by means of a questionnaire and physical examination on 30 male professional soccer players of mean age 24.4 years (range: 18–30). The mean duration of the symptoms was 18.6 months (range: 13–28). The diagnosis was made through clinical investigation, special maneuvers and complementary examinations, by the same examiner. All the patients underwent surgical treatment after conservative treatment failed; all procedures were performed by the same surgeon using the same technique. Nonparametric comparisons were made to investigate the time taken to recover after the surgery, for the patients to return to their sport. Results five patients evolved with hematoma, with the need to remove the stitches three weeks after the operation because of a small dehiscence at the site of the operative wound. The wound healed completely in all these cases by five weeks after the surgery. Four patients presented dysuria in the first week, but improved in the second postoperative week. The mean time taken to return to training was around eight weeks (range: seven–nine). All the players returned to competitive soccer practice within 16 weeks. When asked about their degree of satisfaction after the operation (satisfied or dissatisfied), taking into consideration their return to the sport, there was 100% satisfaction, and they returned to professional practice at the same competitive level as before the injury. This degree of satisfaction continued to the last assessment, which was made after 36 months of postoperative follow-up. Conclusion the surgical technique presented in this case series, with trapezoidal resection of the pubic symphysis in association with bilateral partial tenotomy of the long adductor, was a fast and effective procedure with a low rate of postoperative complications. It was shown to be an excellent treatment option for refractory cases, with a return to sports activity among professional soccer players.
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Affiliation(s)
| | | | | | - César Janovsky
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Moisés Cohen
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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26
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Osteitis pubis: can early return to elite competition be contemplated? Transl Med UniSa 2014; 10:52-8. [PMID: 25147768 PMCID: PMC4140431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND PURPOSE In elite athletes, osteitis pubis is a common painful degenerative process of the pubic symphysis and surrounding soft tissues and tendons. We report the diagnostic pathway and the rehabilitation protocol of six elite athletes with osteitis pubis in three different sports, and compare protocol stages and time to return to competition. METHODS 6 athletes (2 soccer, 2 basketball, 2 rugby players) were diagnosed with osteitis pubis stage III and IV according to Rodriguez classification using standard clinical and imaging criteria. After performing a baseline lumbo-pelvic assessment, the rehabilitation protocol described by Verrall was adapted to each individual athlete. RESULTS The length of time for each stage of the protocol was as follows; Stage 1 (rest from sport) was 26 +/- 5 days, Stage 2 (to achieve pain free running), 18 +/- 5 days, Stage 3 (squad training) 63 +/- 7, Stage 4 (return to competition) 86 +/- 15. Soccer players took longer to return to competition than basketball and rugby players. No recurrences were reported at 2 year follow-up. CONCLUSION The protocol presented ensures a safe return to elite athletes. The time from diagnosis to full recovery is longer in football players, and seems to increase with age.
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27
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Robison CM, Gor RA, Metro MJ. Pubic bone osteomyelitis after salvage high-intensity focused ultrasound for prostate cancer. Curr Urol 2014; 7:149-51. [PMID: 24917777 DOI: 10.1159/000356268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/05/2013] [Indexed: 11/19/2022] Open
Abstract
High-intensity focused ultrasound can be used for the primary treatment of prostate cancer and biochemical recurrence after radical prostatectomy or radiation. Complications of high-intensity focused ultrasound include urinary retention, urethral stenosis, stress incontinence, urinary tract infections, dysuria, impotence, and rarely, rectourethral or rectovesicular fistula. We describe a patient presenting with urinary retention, urinary tract infections and intermittent stress incontinence, later found to be associated with pubic bone osteomyelitis stemming from a prostatopubic fistula.
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Affiliation(s)
| | - Ronak A Gor
- Department of Urology, Einstein Medical Center, Philadelphia, Pa., USA
| | - Michael J Metro
- Traumatic and Reconstructive Urology, Einstein Medical Center, Philadelphia, Pa., USA
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28
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Hechtman KS, Zvijac JE, Popkin CA, Zych GA, Botto-van Bemden A. A minimally disruptive surgical technique for the treatment of osteitis pubis in athletes. Sports Health 2012; 2:211-5. [PMID: 23015940 PMCID: PMC3445106 DOI: 10.1177/1941738110366203] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Multiple surgical procedures exist for the treatment of osteitis pubis: curettage of the symphysis joint, wedge resection, complete resection of the joint, placement of extraperitoneal retropubic synthetic mesh, and arthrodesis of the joint. However, a paucity of literature has reported long-term successful outcomes with the aforementioned approaches. Patients treated operatively have reported recalcitrant pain resulting from iatrogenic instability. The article presents the results of a conservative operative technique that avoids disruption of adjacent ligaments. Hypothesis: Preserving the adjacent ligamentous structures will allow competitive athletes to return to competition and activities of daily living free of iatrogenic pelvic instability and pain. Study Design: Case series. Methods: Four competitive athletes (2 professional and 2 collegiate football players) diagnosed with osteitis pubis were treated conservatively for a minimum of 6 months. Patients underwent surgical intervention upon failure to respond to nonoperative management. The degenerative tissue was resected, allowing only bleeding cancellous bone to remain while preserving the adjacent ligaments. An arthroscope was used to assist in curettage, allowing the debridement to be performed through a small incision in the anterior capsule. Results: The symptoms of all 4 patients resolved, and they returned to competitive athletics. This ligament-sparing technique provided a solid, stable repair and pain relief. Conclusion: This surgical technique preserves the adjacent ligamentous structures and allows competitive athletes to return to competition and activities of daily living free of pain and void of pelvic instability. Clinical Relevance: This technique is a surgical treatment option for athletes with osteitis pubis who fail conservative treatment.
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30
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Sohn KM, Kim YS, Cheon S, Jung H, Koo SH, Hwang DS. Community-Onset Extended-Spectrum Beta-Lactamase-Producing Escherichia coliOsteomyelitis of the Pubic Symphysis. Infect Chemother 2011. [DOI: 10.3947/ic.2011.43.3.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyung Mok Sohn
- Department of Internal Medicine, Chungnam National University Hospital, Daejon, Korea
| | - Yeon-Sook Kim
- Department of Internal Medicine, Chungnam National University Hospital, Daejon, Korea
| | - Shinhye Cheon
- Department of Internal Medicine, Chungnam National University Hospital, Daejon, Korea
| | - Hyeon Jung
- Department of Internal Medicine, Chungnam National University Hospital, Daejon, Korea
| | - Sun Hoe Koo
- Department of Laboratory Medicine, Chungnam National University Hospital, Daejon, Korea
| | - Deuk-Soo Hwang
- Department of Orthopedic Surgery, Chungnam National University Hospital, Daejon, Korea
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31
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Dunk RA, Langhoff-Roos J. Osteomyelitis of the pubic symphysis after spontaneous vaginal delivery. BMJ Case Rep 2010; 2010:bcr0120102610. [PMID: 22789689 PMCID: PMC3030074 DOI: 10.1136/bcr.01.2010.2610.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Osteomyelitis ossis pubis is a painful disorder. It is rare following a normal vaginal delivery. In two cases, the diagnosis was verified by an ultrasound-guided needle aspiration postpartum. Both recovered after treatment with relevant antibiotics. The condition is easily misinterpreted as one of more common disorders like pelvic girdle pain, inflammation, diastasis or distortion of the pubic symphysis joint. If not recognised and treated, the condition can have severe consequences.
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Affiliation(s)
- Rikke Arildsen Dunk
- Department of Gynaecology and Obstetrics, Rigshospitalet, Copenhagen, Denmark.
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32
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Tiemann AH, Röhm C, Hofmann GO. Putrid infectious pubic osteitis: case report and review of the literature on the differential diagnosis and treatment of infectious pubic osteitis and inflammatory pubic osteitis. Eur J Trauma Emerg Surg 2010; 36:481-7. [PMID: 26816230 DOI: 10.1007/s00068-010-0012-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 01/05/2010] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The differential diagnosis of osteolytic, destructive, and inflammatory processes around the symphysis, the os pubis, and the ramus ossis pubis includes infectious osteitis pubis, inflammatory osteitis pubis, posttraumatic benign pubic osteolyses in elderly women, and malignant neoplasia. Accurate diagnosis can be a challenge and requires a methodical approach and the use of a variety of diagnostic measures. MATERIALS A case study of an 83-year-old female suffering from infectious pubis osteitis sheds light on the differential diagnosis of these conditions, particularly the distinction between infectious pubic osteitis and inflammatory pubis osteitis. In addition to the diagnostic indicators and methodologies, differential treatments are considered and a review of current literature on the topic is presented.
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Affiliation(s)
- A H Tiemann
- Abteilung für Septische und Rekonstruktive Chirurgie, Klinik für Unfall- und Wiederherstellungschirurgie, BG-Kliniken Bergmannstrost Halle (Saale), Merseburger Str. 165, 06112, Halle, Germany.
| | - C Röhm
- Abteilung für Septische und Rekonstruktive Chirurgie, Klinik für Unfall- und Wiederherstellungschirurgie, BG-Kliniken Bergmannstrost Halle (Saale), Merseburger Str. 165, 06112, Halle, Germany
| | - G O Hofmann
- Klinik für Unfall- und Wiederherstellungschirurgie, BG-Kliniken Bergmannstrost Halle (Saale), Merseburger Str. 165, 06112, Halle, Germany
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Bali K, Kumar V, Patel S, Mootha AK. Tuberculosis of symphysis pubis in a 17 year old male: a rare case presentation and review of literature. J Orthop Surg Res 2010; 5:63. [PMID: 20799960 PMCID: PMC2939629 DOI: 10.1186/1749-799x-5-63] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 08/27/2010] [Indexed: 11/30/2022] Open
Abstract
Tuberculosis of symphysis pubis is a rare condition with hardly any report of such cases in the last decade. It is necessary to distinguish the entity from more common ones like Osteitis pubis and Osteomyelitis of pubis symphysis by urgent means in order to start the treatment early and thereby minimize morbidity and prevent complications. A rare case of tuberculosis of symphysis pubis in a 17 year old male is described. A high index of suspicion along with an extensive workup including 3-phase bone scan and fine needle aspiration led to the diagnosis. The patient had an excellent outcome following a complete course of multidrug chemotherapy for tuberculosis.
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Affiliation(s)
- Kamal Bali
- Deptt of Orthopaedics, PGIMER, Chandigarh, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh-160 012, India.
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Abstract
Septic arthritis of the pubic symphysis is a rare condition but one which has typical clinical characteristics and known risk factors. It should be considered in the differential diagnosis of all children presenting with groin or hip pain that is exacerbated when walking. Clinical suspicion should prompt magnetic resonance imaging. We report such a case in an 11-year-old boy, discuss current knowledge of its epidemiology and microbiology, and outline recommended practice for investigation and treatment.
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35
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Choi H, McCartney M, Best TM. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med 2008; 45:57-64. [PMID: 18812419 DOI: 10.1136/bjsm.2008.050989] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The authors examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options provide optimal pain relief with rapid return to sport and prevention of symptom reoccurrence. METHODS Three databases-MEDLINE, Cochrane Database of Systematic Reviews and CINAHL-were searched using the OVID interface for all years between 1985 and May 2008. References were analysed from included studies, and additional relevant articles were obtained for inclusion. Inclusion criteria included (1) humans only, (2) subjects had no apparent risk factors for development of osteitis pubis or osteomyelitis of the pubic symphysis other than athletic involvement, (3) both physical exam findings and diagnostic imaging were used to confirm either diagnosis, and (4) a definitive treatment strategy was identifiable for management of osteitis pubis or osteomyelitis of the pubic symphysis. In total, 25 articles were included in the review. RESULTS There were no randomised controlled trials identified with this study's search strategy. A total of 195 athletes were diagnosed as having osteitis pubis (186 males, nine females) and treated with either conservative measures/physical therapy, local injection with corticosteroids and/or local anaesthetic, dextrose prolotherapy, surgery or antibiotic therapy. Six case reports/series described conservative treatment measures (physical therapy, rest, non-steroid anti-inflammatory drugs). Four case series explored the use of corticosteroid injections in treatment. One case series described the use of dextrose prolotherapy as a treatment modality. Six case series described various surgical techniques (pubic symphysis curettage, polypropylene mesh placement and pubic bone stabilisation) in treatment. Ten case reports/series (10 subjects) outlined antibiotic treatment of osteomyelitis of the pubic symphysis. CONCLUSIONS The current medical literature shows only level 4 evidence of the treatment for osteitis pubis in 24 case reports/series in athletes. Without any direct comparison of treatment modalities, it is difficult to determine which individual treatment option is the most efficacious. Further study comparing the different treatment options is necessary to determine which modality provides the fastest return to sport.
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Affiliation(s)
- Haemi Choi
- The Ohio State University Sports Medicine Center, Columbus, 43221, USA.
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Naqvi N, Naqvi R, Wong C, Pearce S. A novel observation of pubic osteomyelitis due to Streptococcus viridans after dental extraction: a case report. J Med Case Rep 2008; 2:255. [PMID: 18671843 PMCID: PMC2517070 DOI: 10.1186/1752-1947-2-255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 07/31/2008] [Indexed: 11/10/2022] Open
Abstract
Introduction Pubic osteomyelitis should be suspected in athletic individuals with sudden groin pain, painful restriction of hip movements and fever. It is an infrequent and confusing disorder, which is often heralded by atypical gait disturbance and diffuse pain in the pelvic girdle. The most common pathogen is Staphylococcus aureus but, on occasions, efforts to identify infectious agents sometimes prove negative. Pubic osteomyelitis due to Streptococcus viridans has not been reported previously in the literature. Case presentation We describe the case of a fit 24-year-old athlete, who had a wisdom tooth extracted 2 weeks prior to the presentation, which could have served as a port of entry and predisposed the patient to transient bacteraemia. Conclusion S. viridans is well known for causing infective endocarditis of native damaged heart valves, but to the best of the authors' knowledge it has not been reported previously as a cause of pubic osteomyelitis. We believe that this case should alert physicians to the association between dental procedures and osteomyelitis of the pubis secondary to S. viridans.
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Affiliation(s)
- Naseem Naqvi
- Department of Acute Medicine, Dumfries & Galloway Royal Infirmary, UK.
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Sánchez Gómez P, Lajara Marco F, Ricon Recarey F. Dolor suprapúbico en escolar de 14 años. An Pediatr (Barc) 2008; 68:536-8. [DOI: 10.1157/13120213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Palmieri O, Corti M, Villafañe M. Osteítis pubiana como causa de síndrome febril prolongado. Rev Clin Esp 2008; 208:110-1. [DOI: 10.1157/13115213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Malakzadeh-Shirvani P, Wikholm E, Assaf A. Osteitis pubis simulating a soft-tissue lesion. Can J Surg 2007; 50:E17-E18. [PMID: 18067693 PMCID: PMC2386232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
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Gamble K, Dardarian TS, Finstein J, Fox E, Sehdev H, Randall TC. Osteomyelitis of the pubic symphysis in pregnancy. Obstet Gynecol 2006; 107:477-81. [PMID: 16449156 DOI: 10.1097/01.aog.0000199146.42113.0b] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pubic symphysis osteomyelitis during the antepartum period of pregnancy is rare. CASE We report a patient in the third trimester who presented with pubic pain, low-grade fever, and altered gait. She was found to have a retropubic abscess at the time of cesarean delivery. Radiologic imaging showed findings consistent with osteomyelitis of the pubic symphysis and multiple pus collections in the pelvis and labia. The patient was treated with surgical debridement of the affected bone and placement of antibiotic-impregnated beads. CONCLUSION Osteomyelitis of the pubic symphysis can have serious complications. The diagnosis should be considered in pregnant patients with clinical findings unusual for pubic symphysis diastases. It can be treated with antibiotic-impregnated beads.
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Affiliation(s)
- Kendra Gamble
- Pennsylvania Hospital Department of Obstetrics and Gynecology, Pennsylvania, USA.
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Abstract
Sports injuries to the hip and groin region have been noted in 5% to 9% of high school athletes. These injuries occur most commonly in athletes participating in sports involving side-to-side cutting, quick accelerations and decelerations, and sudden directional changes.Symptoms may range from intermittent episodes of mild discomfort to severe and chronic career-ending pain. Groin injuries may result from a variety of causes. Although this article deals mainly with athletic etiologies, the physician must keep in mind that many other medical conditions may also affect the groin. Because of these overlapping medical conditions and because the anatomy of the region is so complex, a team approach is optimal. In the second of this two-part series, disorders of the os pubis, stress fractures and various hip pathologies are reviewed as causes of groin pain.
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Affiliation(s)
- Vincent Morelli
- Primary Care Sports Medicine Fellowship, Louisiana State University Health Sciences Center, 200 West Esplanade Avenue, Suite 412, Kenner, LA 70065, USA.
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Meirovitz A, Gotsman I, Lilling M, Bogot NR, Fridlender Z, Wolf DG. Osteomyelitis of the pubis after strenuous exercise. A case report and review of the literature. J Bone Joint Surg Am 2004; 86:1057-60. [PMID: 15118053 DOI: 10.2106/00004623-200405000-00027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Amichay Meirovitz
- Departments of Medicine, Hadassah University Hospital, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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Abstract
We report a novel case of septic arthritis of the symphysis pubis due to Streptococcus pneumoniae and review 99 previously reported cases of infection of this joint. Typical features of pubic symphysis infection included fever (74%), pubic pain (68%), painful or waddling gait (59%), pain with hip motion (45%), and groin pain (41%). Risk factors included female incontinence surgery (24%); sports, especially soccer (19%); pelvic malignancy (17%); and intravenous drug use (15%). Septic arthritis of the pubic symphysis is often misdiagnosed as osteitis pubis, a sterile inflammatory condition. Causative organisms differed according to risk factors. Staphylococcus aureus was the major cause among athletes, Pseudomonas aeruginosa among intravenous drug users, and infections among patients with pelvic malignancies were usually polymicrobial, involving fecal flora. Patients with recent urinary incontinence surgery usually had monomicrobial infection, with no predominant pathogen. Since osteomyelitis is present in 97% of patients, we recommend antibiotic courses of 6 weeks' duration. Surgical debridement is required in 55% of patients.
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Affiliation(s)
- John J Ross
- Division of Infectious Diseases, Caritas Saint Elizabeth's Medical Center, 736 Cambridge Street, Boston, MA 02135-2997, USA.
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Abstract
Hip arthroscopy is being used increasingly for the diagnosis and treatment of hip disorders. MR imaging performed with appropriate technical considerations may aid not only in preoperative planning but in the appropriate selection of patients, which tends to lead to better postoperative results. Although the painful hip is imaged most commonly by radiography, MR imaging is considered the next imaging test of choice for evaluation of most common hip abnormalities in athletes, including labral injuries, ligament injuries, osteochondral injuries, fractures, bursitis, and musculotendinous injuries. MR arthrography can be a particularly useful technique for dedicated assessment of hip joint internal derangements.
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Affiliation(s)
- Robert D Boutin
- Med-Tel International, 3713 Lillard Drive, Davis, CA 95616, USA
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