Postpartum Pubic Symphysis Diastasis: A Case Report

We present the case of a 25-year-old African American female patient (G1P0) with a past medical history of brain arteriovenous malformation repair, pneumonia, and a urinary tract infection who was admitted to the labor and delivery floor at 39 weeks for a spontaneous vaginal delivery of a 4.025 kg female baby. In the immediate postpartum (PP) period, the patient presented with severe pelvic pain and trouble ambulating. Conservative management of oral non-narcotic analgesics was initiated until the diagnosis of PP pubic symphysis diastasis (PSD) was made. Due to the persistence of pelvic pain, the patient underwent a pubic symphysis joint steroid injection and was discharged on day 8. Within 24 hours of discharge, the patient was readmitted to the emergency department with severe pain and an inability to walk. Her pain was managed conservatively with intravenous narcotics and non-steroidal anti-inflammatories, which quickly dissipated the pain. She was observed and discharged once she reported improvement in pain, and she was reassessed five days later at her obstetrician's clinic. In the clinic, the patient presented with mild tenderness in the pubic symphysis region but demonstrated improvement in her antalgic gait with an ability to walk and urinate without difficulty. Despite a lack of follow-up imaging, the patient was reassured that her PSD and associated tenderness should completely resolve within three to four months.

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.