Radiographic findings after pubic symphysiotomy: mean time to follow-up of 41.6 years

Late-Onset Sacroiliac Osteoarthritis After Surgical Symphysiotomy: A Case Report

A 35-year-old female presented with right-sided gluteal pain and difficulty in walking 10 years after surgical symphysiotomy. Radiograph of the pelvis and bilateral hip joints showed osteoarthritis of the right sacroiliac joint with pubic diastasis of 1.5 cm. She was operated with pubis symphysis reduction and fixation using two orthogonal plates with one iliosacral screw. Postoperative period was uneventful. She was able to walk independently after three months of fixation. Follow-up at 18 months showed complete relief of symptoms with maintenance of reduction and no hardware breakage. The Lindahl score was 78, indicating an excellent outcome.

The cup-cage reconstruction for pelvic discontinuity has encouraging patient satisfaction and functional outcome at median 6-year follow-up

INTRODUCTION

The aim of this study was to review the clinical, radiological and patient-reported outcomes with the use of cup-cage construct for pelvic discontinuity at our institution.

METHODS

24 patients were identified at median 6-year (minimum 2 year, maximum 10 years) follow-up. 1 patient was converted to excision arthroplasty for infection. A further 3 patients required revision for instability but the cup-cage construct was not revised.

RESULTS

We noted encouraging pain relief (mean WOMAC pain 85.6) and good functional outcome (mean WOMAC function 78.2, mean UCLA 5, mean OHS 78.6). Patient satisfaction with regards pain relief, function and return to recreational activities were noted to be good.

CONCLUSIONS

The cup-cage construct is a viable method of dealing with complex pelvic discontinuity. However, the failure rate due to loosening (4 cases) in this and other reports does prompt the need for further refinement of the technique and technology in this very challenging group of patients, as well as continued evaluation at the mid- and long-term so as to confirm the ongoing success of this method of reconstruction.

Symphysiotomy for obstructed labour: a systematic review and meta-analysis

BACKGROUND

Obstructed labour is a major cause of maternal mortality. Caesarean section can be associated with risks, particularly in low- and middle-income countries, where it is not always readily available. Symphysiotomy can be an alternative treatment for obstructed labour and requires fewer resources. However, there is uncertainty about the safety and effectiveness of this procedure.

OBJECTIVES

To compare symphysiotomy and caesarean section for obstructed labour.

SEARCH STRATEGY

MEDLINE, EMBASE, Cochrane library, CINAHL, African Index Medicus, Reproductive Health Library and Science Citation Index (from inception to November 2015) without language restriction.

SELECTION CRITERIA

Studies comparing symphysiotomy and caesarean section in all settings, with maternal and perinatal mortality as key outcomes.

DATA COLLECTION AND ANALYSIS

Quality of the included studies was assessed using the STROBE checklist and the Newcastle Ottawa scale. Relative risks (RR) were pooled using the random effects model. Heterogeneity was assessed using I(2) tests.

MAIN RESULTS

Seven studies (n = 1266 women), all of which were set in low- and middle-income countries (as per the World Bank definition) and compared symphysiotomy and caesarean section were identified. Meta-analyses showed no significant difference in maternal (RR 0.48, 95% CI 0.13-1.76; P = 0.27) or perinatal (RR 1.12, 95% CI 0.64-1.96; P = 0.69) mortality with symphysiotomy when compared with caesarean section. There was a reduction in infection (RR 0.30, 95% CI 0.14-0.62) but an increase in fistulae (RR 4.19, 95% CI 1.07-16.39) and stress incontinence with symphysiotomy (RR 10.04, 95% CI 3.23-31.21).

CONCLUSION

There was no difference in key outcomes of maternal and perinatal mortality with symphysiotomy when compared with caesarean section.

TWEETABLE ABSTRACT

Symphysiotomy could be an alternative to caesarean section when resources are limited.

The Irish experience of Symphysiotomy: 40 years onwards

The art of symphysiotomy for delivery in the instance of cephalopelvic disproportion has been a dying art since the advent of caesarean section but in Ireland this surgical procedure was not abolished until 1992. This practice is still present in the developing world and in some circumstances used in developed countries. This study offers some insights on the 40-year follow-up of patients who had undergone symphysiotomy.

Fracture non-union epidemiology and treatment

Fracture non-union remains a clinical problem despite advances in the understanding of basic science and technology. Each fracture has a unique personality as does the patient suffering the injury. Thus, each case must be treated on an individual basis. This article defines the problem of fracture non-union and reports recent epidemiological studies. We discuss relevant risk factors and methods for assessing patients who have a tendency toward fracture non-union. There are many treatment options for patients with non-union, where a number of these modalities are still under review. We discuss current evidence with the use of bone morphogenic protein, platelet-rich plasma and low-intensity pulsed ultrasound to augment the treatment of fracture non-union.