A double-barrelled fibula graft restoring pelvic stability after late posterior ring instability related to a surgical treated osteitis pubis: a case report.
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.


METHODS
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.


CONCLUSIONS
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.
Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. Philipp.Pieroh@medizin.uni-leipzig.de.|Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06097, Halle (Saale), Germany. Philipp.Pieroh@medizin.uni-leipzig.de.
Philipp
P
Pieroh
Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. Nick.Spindler@medizin.uni-leipzig.de.
Nick
N
Spindler
Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. Stefan.Langer@medizin.uni-leipzig.de.
Stefan
S
Langer
Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. Christoph.Josten@medizin.uni-leipzig.de.
Christoph
C
Josten
Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. Joerg.Boehme@medizin.uni-leipzig.de.
Jörg
J
Böhme
D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005360:Fibula / Q000637:transplantation*; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D010000:Osteitis / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D011631:Pubic Symphysis / Q000601:surgery*
Fibula graft; Osteitis pubis; Pelvic instability; Pelvic reconstruction