Date: Thu, 26 Jun 2003 16:00:10 -0400

Subject: Pubic Injury

Please find attached a case for the discussion list.

This patient is a 45 yo female who was in a motor vehicle accident 11 months ago. She suffered an open humerus fracture which has healed and pubic rami fractures. Her initial films are too dark for electronic submission.

Over the first 6 months post-injury, she developed increasing pelvic pain She has a wadlling gait and dyspareunia. Pain is increased with activity.

On physical examination, she is tender at her symphysis and over the left superior ramus. Her lateral compression test is non painful, yet her cross-over leg test is painful.

She has had a recent episode of vaginal bleeding and a history of a TVH. Her OB MD has seen her twice and finds no OB cause for her dyspareunia or bleeding. He also sees no scar which would indicate that he rami fractures were open. She did not have a vaginal exam at the time of her accident.

I think she has osteitis pubis. A recent A/P pelvis and CT are attached.
She can not tolerate oral non-steroidals.
She has recently had an injection.

Is my diagnosis correct?
Does anyone have any experience with anti-coagulants as a treatment?
Surgery at what point?
Stover et al suggest that the wedge resection is potentailly complicated by SI DJD. Is a fusion a better option?
Other thoughts?

Thank You in advance for your time and experitise.

Bob Zura
Medical College of Georgia

Date: Thu, 26 Jun 2003 19:18:42 -0700

From: Chip Routt

Your diagnosis could be correct.

Does the CT demonstrate complete union of the ramus fractures?

What kind of injection and where and did it cause relief and for how long?

Most patients seem to improve over time with local care, or maybe they just have someone else operate on them!

M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
Seattle, WA 98104-2499

Date: Fri, 27 Jun 2003 06:27:59 -0400

From: Robert Zura

Thank you for your response.

I thought the CT demonstrated union of the fractures - that is why I got it.

The injection was last week - she had reasonable relief after the procedure - I do not know how long her relief lasted.

Thank You

Bob Zura