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Annals of Medical and Health Sciences... 2015During pregnancy, high progesterone and relaxin levels produce physiological ligament relaxation on the pelvis. Therefore, moderate pubic symphysis and sacroiliac joints...
During pregnancy, high progesterone and relaxin levels produce physiological ligament relaxation on the pelvis. Therefore, moderate pubic symphysis and sacroiliac joints relaxing provide birth canal widening, thereby facilitating vaginal delivery. Sometimes, functional pain or pelvic instability may occur during pregnancy or puerperium, which is defined as symptomatic pelvic girdle relaxation. In rare cases, a pubic symphysis disruption can occur during the labor, causing severe pain and functional limitations. The early recognition of this injury is crucial to prevent complications and improve clinical and functional outcomes. This study reports an acute symphyseal disruption resulting from childbirth in a primiparous patient who underwent open reduction and internal fixation with plate and screws. After a 6 months follow-up, the patient presented no pain and satisfactory functional recovery.
PubMed: 27057391
DOI: 10.4103/2141-9248.177980 -
Journal of Experimental Orthopaedics Sep 2020Instability of the pubic symphysis often results in a poor outcome and reduced mobility of the patient. In some cases, an arthrodesis of the pubic symphysis is required....
OBJECTIVE
Instability of the pubic symphysis often results in a poor outcome and reduced mobility of the patient. In some cases, an arthrodesis of the pubic symphysis is required. Until today, there is no data published how many of these procedures are performed annually and there is also no data about the outcome after this extensive surgery.
METHODS
We developed a novel surgical technique to address the arthrodesis of the pubic symphysis in a minimally invasive approach. Therefore, we used for this purpose modified instruments and performed the transplantation of a cylindrical bone substitute into the pubic symphysis, without an extensive approach or dissecting the anterior or posterior symphyseal ligaments.
RESULTS
Using this novel technique, a minimally invasive symphysiodesis was achieved in radiological findings, after the procedure.
CONCLUSION
Thus, this actually minimally invasive surgical technique seems to be a promising advancement for the arthrodesis of the pubic symphysis.
PubMed: 32940814
DOI: 10.1186/s40634-020-00284-0 -
BMJ Case Reports Sep 2019Urachal sinus usually presents with umbilical discharge and the opening can rarely be located between the umbilicus and the symphysis pubis and the so called suprapubic... (Review)
Review
Urachal sinus usually presents with umbilical discharge and the opening can rarely be located between the umbilicus and the symphysis pubis and the so called suprapubic sinus (SPS). There is another different entity of cases reported in literature with a similar presentation but with an opening anywhere between the umbilicus and symphysis pubis but differs from SPS in the pathway of the tract and the epithelial lining. We report a case of a 2-year-old boy presenting with a prepubic sinus that was managed with surgical excision. After a thorough literature review, we compare our case to other prepubic and SPS.
Topics: Child, Preschool; Cutaneous Fistula; Epithelium; Humans; Male; Pubic Symphysis; Urachus
PubMed: 31511268
DOI: 10.1136/bcr-2019-231138 -
Il Giornale Di Chirurgia 2020Athletic pubalgia presents with groin and/or pubic pain mainly in athletes. The purpose of this review is to analyze, by evaluating current literature, the clinical... (Review)
Review
Athletic pubalgia presents with groin and/or pubic pain mainly in athletes. The purpose of this review is to analyze, by evaluating current literature, the clinical examination and differential diagnosis of athletic pubalgia, in an effort to better understand this clinical entity. Diagnosis is challenging due to the anatomical complexity of the groin area, the biomechanics of the pubic Romasymphysis region and the large number of potential sources of groin pain. Clinical examination and medical history are of utmost importance. Differential diagnosis includes intra-and-extra-articular hip and intra-abdominal pathology, as well as non-myoskeletal disorders, such as femoroacetabular impingement (FAI), acetabular labral tears, osteitis pubis, adductor muscles injuries and true inguinal hernia. A thorough clinical examination should be performed in such cases, including the "Resisted sit-up" and the "Single or Bilateral Resisted Leg Adduction" test. Regarding imaging, Magnetic resonance imaging (MRI) should be performed when athletic pubalgia is suspected, especially in athletes. Other imaging techniques, such as plain radiographs and ultrasonography may add to the diagnostic process.
Topics: Abdominal Pain; Acetabulum; Athletes; Diagnosis, Differential; Femoracetabular Impingement; Groin; Hernia, Inguinal; Humans; Magnetic Resonance Imaging; Medical History Taking; Muscle, Skeletal; Osteitis; Physical Examination; Pubic Symphysis; Radiography; Ultrasonography
PubMed: 32038025
DOI: No ID Found -
JNMA; Journal of the Nepal Medical... Dec 2023The pubic symphysis is a midline, non-synovial joint connecting the right and left superior pubic rami. The joint allows very limited movement of approximately 0.5-1 mm....
UNLABELLED
The pubic symphysis is a midline, non-synovial joint connecting the right and left superior pubic rami. The joint allows very limited movement of approximately 0.5-1 mm. Under hormonal stimulation during pregnancy, the widening of the symphysis pubis and sacroiliac joints occurs. Pubic symphysis diastasis is defined as the widening of the pubic joint of >10 mm. It is a rare complication of vaginal childbirth for which no gold standard treatment has been defined. Most cases are treated conservatively. A case of pubic diastasis in a 24-year-old G5P2A2L1 following vaginal delivery is reported. Management consisted of simple conservative treatment, which was sufficient in achieving symptomatic relief.
KEYWORDS
case reports; pelvic pain; pubic symphysis diastasis.
Topics: Pregnancy; Female; Humans; Young Adult; Adult; Pubic Symphysis Diastasis; Pubic Symphysis; Postpartum Period; Delivery, Obstetric; Conservative Treatment
PubMed: 38289751
DOI: 10.31729/jnma.8375 -
Injury Dec 2023To compare the clinical efficacy of two surgical interventions in treating advanced stages TB of the pubis and pubic symphysis.
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.
Topics: Humans; Adult; Retrospective Studies; Blood Loss, Surgical; Tuberculosis, Spinal; Pubic Bone; Pubic Symphysis; Thoracic Vertebrae; Spinal Fusion; Debridement; Treatment Outcome; Lumbar Vertebrae
PubMed: 37919114
DOI: 10.1016/j.injury.2023.111155 -
Acta Orthopaedica Et Traumatologica... Mar 2017The aim of this study was to create a reference about normal pubic symphysis and sacroiliac joint widths of children and adolescents.
OBJECTIVE
The aim of this study was to create a reference about normal pubic symphysis and sacroiliac joint widths of children and adolescents.
METHODS
A total of 1020 computerized tomography axial scans of patients without pelvic injury between 2 and 18 year-old were studied. The narrowest width of pubic symphysis and bilateral sacroiliac joints were measured.
RESULTS
The average pubic symphyseal width at 2 years old boys was 6.35 ± 1.06 mm (4.88-9.13 mm). The average of right and left sacroiliac joints' widths at 2 years old boys was 4.56 ± 0.65 mm (3.59-6.07 mm) and 4.58 ± 0.66 mm (3.44-5.74 mm), respectively. The average pubic symphyseal width of 2 years old girls was 5.85 ± 1.14 mm (4.06-8.20 mm). The average of right and left sacroiliac joints' widths at 2 years old girls was found 4.36 ± 0.56 mm (3.50-5.37 mm) and 4.42 ± 0.59 mm (3.58-5.73 mm), respectively. The average pubic symphyseal width at 18 years old boys was found 3.68 ± 1.30 mm (1.90-5.79 mm). The average of right and left sacroiliac joints' widths at 18 years old boys was found 1.97 ± 0.21 mm (1.73-2.41 mm) and 2.04 ± 0.30 mm (1.70-2.65 mm), respectively. The average pubic symphyseal width at 18 years old girls was 3.92 ± 0.52 mm (2.97-4.76 mm). The average of right and left sacroiliac joints' widths at 18 years old girls was found 2.34 ± 0.40 mm (1.58-3.34 mm) and 2.33 ± 0.37 mm (1.58-3.10 mm), respectively.
CONCLUSION
Our results suggest that one should be suspicious about pelvic injury if the width of pubic symphysis is over 10 mm and width of sacroiliac joint is over 8 mm especially in patients younger than 10 years-old.
LEVEL OF EVIDENCE
Level III Diagnostic study.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Male; Pubic Symphysis; Pubic Symphysis Diastasis; Reference Values; Sacroiliac Joint; Tomography, X-Ray Computed
PubMed: 28246048
DOI: 10.1016/j.aott.2017.02.008 -
Journal of Orthopaedic Trauma Apr 2021Examine factors associated with fixation failure in patients treated with superior intramedullary ramus screws.
OBJECTIVE
Examine factors associated with fixation failure in patients treated with superior intramedullary ramus screws.
DESIGN
Retrospective.
SETTING
Single, Level 1 trauma center.
PATIENTS
Unstable pelvic ring fractures amenable fixation that included superior intramedullary ramus screws.
INTERVENTION
Percutaneously inserted intramedullary superior ramus screw fixation of superior pubic ramus (SPR) fractures.
MAIN OUTCOME MEASUREMENTS
Loss of reduction (LOR) of the SPR fracture defined as >2 mm displacement on pelvic radiographs at any time point in follow-up.
RESULTS
Two hundred eighty-five fractures in 211 patients (age 44, 95% confidence interval 40.8%-46.4%, 59.3% women, 55.1% retrograde screws) were included in the analysis. 14 (4.9%) of fractures had LOR. Patients were significantly more likely to have LOR as age increased (P = 0.01), body mass index (BMI) increased (P = 0.01), and if they were women (P < 0.01). There was a significantly decreased LOR (P < 0.01) as fractures moved further from the pubis symphysis. Retrograde screws were significantly (P < 0.01) more likely to have LOR. In SPR fractures treated with retrograde screws, failure was significantly associated with increasing BMI (P = 0.02), the presence of an inferior ramus fracture (P = 0.02), and trended toward significance with increasing age (P = 0.06), and decreased distance from the symphysis (P = 0.07).
CONCLUSIONS
Superior ramus screws are associated with a low failure rate (4.9%), which is lower than previously reported. Retrograde screw insertion, distance from the symphysis, increasing age, increasing BMI, decreased distance from the symphysis, and ipsilateral inferior ramus fractures were predictors of failure. In these patients, alternative modalities should be considered, although low rates of failure can still be expected.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Adult; Bone Screws; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Middle Aged; Pelvic Bones; Pubic Bone; Retrospective Studies
PubMed: 33727521
DOI: 10.1097/BOT.0000000000001973 -
Journal of Obstetrics and Gynaecology... Aug 2022Symphysis pubis diastasis (SPD) is an uncommon peripartum complication which can have short-term morbidities secondary to pain and restricted movements as well as...
BACKGROUND
Symphysis pubis diastasis (SPD) is an uncommon peripartum complication which can have short-term morbidities secondary to pain and restricted movements as well as long-term complications. It is important to diagnose this condition as it causes significant discomfort to the nursing mothers. We present our experience in five patients with SPD who were managed successfully.
METHODS
Present study is an observation of five cases of SPD managed in a single unit in a tertiary care center over three years from January 2017 to December 2019. All women with symptoms of SPD with inter-pubic distance of more than 10 mm were selected for the study. The demographic profile, clinical details, diagnostic imaging findings, and treatment provided for such patients were noted down from the individual case records. Follow-up of each patient for improvement in the symptoms and X-ray findings was available till 3 months for each case.
RESULTS
Mean age of the women with SPD was 29.8 ± 5.4 years. Four women had vaginal delivery and one had vacuum delivery. Average birth weight is 3.26 ± 0.85 kg. Mean duration of first stage of labor is 6.6 ± 0.89 h and median of second stage is 35 min. Average inter-pubic distance at the time of diagnosis on X-ray was 1.84 ± 0.2 cm. All women were managed conservatively with bed rest, analgesics, pelvic binder and physiotherapy. Improvement in the range of movement was noted over average of 21.8 ± 3.7 days and symptoms resolved over 14.4 ± 2.6 weeks.
CONCLUSION
Treating obstetrician should be aware of this condition as simple treatment measures can avoid the long-term morbidities and complications.
PubMed: 35928090
DOI: 10.1007/s13224-021-01590-y -
World Journal of Clinical Cases Jan 2021Separation of the pubic symphysis can occur during the peripartum period. Relaxin (RLX) is a hormone primarily secreted by the corpus luteum that can mediate hemodynamic...
BACKGROUND
Separation of the pubic symphysis can occur during the peripartum period. Relaxin (RLX) is a hormone primarily secreted by the corpus luteum that can mediate hemodynamic changes during pregnancy as well as loosen the pelvic ligaments. However, it is unknown whether RLX is associated with peripartum pubic symphysis separation and if the association is affected by other factors.
AIM
To study the association between RLX and peripartum pubic symphysis separation and evaluate other factors that might affect this association.
METHODS
We performed a cross-sectional study of pregnant women between April 2019 and January 2020. Baseline demographic characteristics, including gestational age, weight, neonatal weight, delivery mode and duration of the first and second stages of labor, were recorded. The clinical symptoms were used as a screening index during pregnancy, and the patients with pubic symphysis and inguinal pain were examined by color Doppler ultrasonography to determine whether there was pubic symphysis separation. Serum RLX concentrations were evaluated 1 d after delivery using an enzyme-linked immunosorbent assay, and pubic symphysis separation was diagnosed based on postpartum X-ray examination. We used an independent-sample test to analyze the association between serum RLX levels and peripartum pubic symphysis separation. Multivariate regression analysis was used to evaluate whether the association between RLX and peripartum pubic symphysis separation was confounded by other factors, and the association between RLX and the severity of pubic symphysis separation was also assessed. We used Pearson correlation analysis to determine the factors related to RLX levels as well as the correlation between the degree of pubic symphysis separation and activities of daily living (ADL) and pain.
RESULTS
A total of 54 women were enrolled in the study, with 15 exhibiting (observational group) and 39 not exhibiting (control group) peripartum pubic symphysis separation. There were no statistically significant differences in terms of maternal age, gestational age, pre-pregnancy weight, weight gain during pregnancy, delivery modes, or duration of the first or second stages of labor between the 2 groups. We did, however, note a statistically significant difference in serum RLX concentrations and neonatal weight between the observational and control groups (122.3 ± 0.7 µg/mL 170.4 ± 42.3 µg/mL, < 0.05; 3676.000 ± 521.725 g 3379.487 ± 402.420 g, < 0.05, respectively). Multivariate regression analyses showed that serum RLX level [odds ratio (OR): 1.022) and neonatal weight (OR: 1.002) were associated with pubic symphysis separation peripartum. The degree of separation of the pubic symphysis was negatively correlated with ADL and positively correlated with pain. There was no statistically significant association between serum RLX levels and the severity of pubic symphysis separation after adjusting for confounding factors.
CONCLUSION
Serum RLX levels and neonatal weight were associated with the occurrence, but not the severity, of peripartum pubic symphysis separation.
PubMed: 33511175
DOI: 10.12998/wjcc.v9.i1.91